NPIMap

Organization Active NPI

Georgia Em-I Medical Service PC

  • Nurse Practitioner
  • Snellville, GA
National Provider Identifier
1184990202
Registry record updated Mar 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
GEORGIA EM-I MEDICAL SERVICE PC
Practice address
1700 Medical Way
Snellville, GA 30078-2195
Phone
(770) 979-0200
NPI assigned
Mar 23, 2012
Last updated
Mar 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2023

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

Authorized official

Name
Karen Vaughn
Title
Officer
Phone
(973) 251-1132

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X Primary
Emergency Medicine Physician 207P00000X

Addresses

Primary practice location

1700 Medical Way
Snellville, GA 30078-2195

Mailing address

18167 US Highway 19 North Suite 650
Clearwater, FL 33764-3528
Phone (800) 507-8874

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031218000621 GA Part B Supplier - Clinic/Group Practice 0446157218 Receives reassigned benefits from 147 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bremen, GA; Covington, GA

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1332460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679443200000",
    "number": "1184990202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18167 US HIGHWAY 19 NORTH SUITE 650",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337643528",
            "telephone_number": "800-507-8874",
            "fax_number": "727-536-2896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 MEDICAL WAY",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782195",
            "telephone_number": "770-979-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA EM-I MEDICAL SERVICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-23",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A",
        "authorized_official_last_name": "VAUGHN",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "973-251-1132"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Snellville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; 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.