Organization
EMERGENCY MEDICINE SOUTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAM KLEBOSITS (PRACTICE ADMINISTRATOR)
(229) 259-4660
Entity
Organization
Contact information
Practice address
2501 N PATTERSON ST, VALDOSTA, GA 31602
(229) 333-1000
Mailing address
PO BOX 402059, ATLANTA, GA 30384-2059
(229) 333-1000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
261QE0002X
Emergency Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
158191000
FECA US DEPT OF LABOR
—
05
—
256338100
—
FL
05
—
258338100
—
FL
05
—
300033708A
—
GA
01
—
5272824401
BLUE CROSS BLUE SHIELD
GA
Enumeration date
03/24/2006
Last updated
12/12/2008
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