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
351 LIBERTY STREET, WAYNESBORO, GA 30830-9686
(706) 554-4435
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
—
300017172A
—
GA
01
—
CC4853
RR MEDICARE
—
05
—
GPB015
—
SC
Enumeration date
12/08/2010
Last updated
04/29/2013
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