NPIMap

Organization Active NPI

Southland Emergency Medical Services Consolidated, LLC

  • Hospitalist Physician
  • Cochran, GA
National Provider Identifier
1033464391
Registry record updated May 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
SOUTHLAND EMERGENCY MEDICAL SERVICES CONSOLIDATED, LLC
Practice address
145 E Peacock St
Cochran, GA 31014-7846
Phone
(478) 934-6211
NPI assigned
Jul 23, 2012
Last updated
May 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stephanie Fletcher
Title
Cfo
Phone
(292) 236-0831

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU
Hospitalist Physician 208M00000X NU Primary

Addresses

Primary practice location

145 E Peacock St
Cochran, GA 31014-7846

Mailing address

PO Box 102545
Atlanta, GA 30368-2545

Other practice location 1

1221 E McPherson Ave
Nashville, GA 31639-2326
Phone (229) 543-7100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120823000503 GA Part B Supplier - Clinic/Group Practice 4183871320 Receives reassigned benefits from 179 practitioners
Practice locations: Baxley, GA; Cochran, GA; Hiawassee, GA; Louisville, GA; Sandersville, GA; Sylvania, GA; Washington, GA; Waynesboro, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 183

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 183

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559001600000",
    "number": "1033464391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102545",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303682545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 E PEACOCK ST",
            "city": "COCHRAN",
            "state": "GA",
            "postal_code": "310147846",
            "telephone_number": "478-934-6211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1221 E McPherson Ave",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "GA",
            "postal_code": "316392326",
            "country_code": "US",
            "telephone_number": "229-543-7100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHLAND EMERGENCY MEDICAL SERVICES CONSOLIDATED, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-23",
        "last_updated": "2019-05-28",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "292-236-0831"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cochran, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.