Organization
PEACH STATE EMS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEVIN RAY STANCLIFF PARAMEDIC (OWNER)
(678) 828-1250
Entity
Organization
Contact information
Practice address
122 AMY INDUSTRIAL LN, HOSCHTON, GA 30548-2469
(888) 838-1391
(888) 391-8501
Mailing address
PO BOX 545, BRASELTON, GA 30517-0010
(888) 838-1391
(888) 391-8501
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
078-04
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
078-04
GA STATE EMS LICENSE NUMBER
GA
Enumeration date
06/02/2014
Last updated
06/05/2024
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