Organization
LAVONIA EMERGENCY GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN DOMENGEAUX (GENERAL COUNSEL)
(800) 893-9698
Entity
Organization
Contact information
Practice address
367 CLEAR CREEK PKWY, LAVONIA, GA 30553-4173
(706) 356-7800
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
(337) 371-4605
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
09/21/2015
Last updated
09/21/2015
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