Organization
OKEFENOKEE EMS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEREK DANIEL MALLARD EMT-P (CEO)
(912) 284-9111
Entity
Organization
Contact information
Practice address
611 RIVERSIDE AVE, WAYCROSS, GA 31501-5322
(912) 284-9111
Mailing address
PO BOX 1433, 611 RIVERSIDE AVE, WAYCROSS, GA 31502-1433
(912) 284-9111
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
148-05
GA
Other
Enumeration date
11/07/2006
Last updated
08/22/2020
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