Organization
GORDONIA EMERGENCY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER PROVASNIK (SUPERVISOR OF PROVIDER ENROLLMENT)
(800) 355-0808
Entity
Organization
Contact information
Practice address
247 S MAIN ST, REIDSVILLE, GA 30453-4605
(912) 557-1000
Mailing address
PO BOX 41631, PHILADELPHIA, PA 19101-1631
(800) 355-0808
(215) 834-2862
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Enumeration date
07/06/2007
Last updated
08/22/2020
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