NPIMap

Organization Active NPI

Southland Consolidated Emergency Services, LLC

  • Emergency Medicine Physician
  • Elberton, GA
National Provider Identifier
1174917124
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
SOUTHLAND CONSOLIDATED EMERGENCY SERVICES, LLC
Practice address
4 Medical Dr
Elberton, GA 30635-1897
Phone
(706) 283-3151
NPI assigned
Mar 26, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 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
(229) 236-0831

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

4 Medical Dr
Elberton, GA 30635-1897

Mailing address

100 S Madison St
Thomasville, GA 31792-5473
Phone (292) 236-0831

Other identifiers 1

IdentifierTypeStateIssuer
9999999MedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151119001289 GA Part B Supplier - Clinic/Group Practice 2860792066 Receives reassigned benefits from 155 practitioners
Practice locations: Bainbridge, GA; Baxley, GA; Elberton, GA; Forsyth, GA; Louisville, GA; Sandersville, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 158

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 158

NPI Registry JSON

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

{
    "created_epoch": "1427328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1174917124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S MADISON ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317925473",
            "telephone_number": "292-236-0831",
            "fax_number": "229-236-0871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MEDICAL DR",
            "city": "ELBERTON",
            "state": "GA",
            "postal_code": "306351897",
            "telephone_number": "706-283-3151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND CONSOLIDATED EMERGENCY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-26",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "229-236-0831"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9999999",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elberton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.