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Organization

NES GEORGIA, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JENNIFER MOORE (CFO)
(415) 435-4591
Entity
Organization

Contact information

Practice address
163 S TALLAHASSEE ST, HAZLEHURST, GA 31539-6465
(912) 375-7781
(912) 375-4055
Mailing address
PO BOX 277329, ATLANTA, GA 30384-7329
(800) 377-8721
(304) 697-1155

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300017172I
GA
01
CC4853
RR MEDICARE
Enumeration date
11/11/2005
Last updated
04/29/2013
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