Organization
SOUTHLAND EVANS EMERGENCY MEDICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE FLETCHER (CFO)
(229) 236-0831
Entity
Organization
Contact information
Practice address
200 N RIVER ST, CLAXTON, GA 30417-1659
(912) 739-5000
Mailing address
100 S MADISON ST, THOMASVILLE, GA 31792-5473
(229) 236-0831
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
99999999
—
GA
Enumeration date
01/17/2018
Last updated
06/16/2018
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