Southland Optim Jenkins Emergency Medical Services, LLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

SOUTHLAND OPTIM JENKINS EMERGENCY MEDICAL SERVICES, LLC

Doing business as

DBA Southland Liberty Emergency Medical Services

Practice address

455 S Main St Ste 103
Hinesville, GA 31313-4354

Phone

(912) 369-4673

NPI assigned

Mar 2, 2016

Last updated

Mar 2, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stephanie Fletcher, CPA

Title

Chief Financial Officer

Phone

(229) 520-7115

Specialties & licenses 1

Addresses

Other names 1

• DBA Southland Liberty Emergency Medical Services Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Southland Optim Jenkins Emergency Medical Services, LLC

  • Emergency Medicine Physician
  • Millen, GA
  • NPI 1265826242

  O20160107002680

  Same enrollment

Practitioners 62

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.

• Danny L Adams, PA

  • Physician Assistant
  • Athens, GA
  • NPI 1093934788
  NPD
• Olalekan Akinyokunbo, M.D

  • Emergency Medicine Physician
  • Metter, GA
  • NPI 1063806040
  NPD
• William A Benz, PA

  • Physician Assistant
  • Thomasville, GA
  • NPI 1528395928
  NPD
• Tony Bevill, P.A.-C

  • Medical Physician Assistant
  • Collins, GA
  • NPI 1255324489
  NPD
• Julie G. Bird, APRN

  • Family Nurse Practitioner
  • Millen, GA
  • NPI 1073696068
  NPD
• Heather Marie Blackburn, PA-C

  • Physician Assistant
  • Homerville, GA
  • NPI 1114910429
  NPD
• Willy David Booker, PA-C

  • Physician Assistant
  • Fort Stewart, GA
  • NPI 1417920794
  NPD
• Natalie Pippin Britt, MD

  • Family Medicine Physician
  • Savannah, GA
  • NPI 1932489481

  Emergency Medicine

  NPD
• Brenda Gail Bryan, NP-C

  • Family Nurse Practitioner
  • Millwood, GA
  • NPI 1750887675
  NPD
• Joey Bullard, FNP-BC

  • Nurse Practitioner
  • Hinesville, GA
  • NPI 1831731850
  NPD
• Lafayette Burks, MD

  • Emergency Medicine Physician
  • Jesup, GA
  • NPI 1952497760
  NPD
• Kenneth James Burnsed Jr., APRN, FNP-BC

  • Family Nurse Practitioner
  • Thomasville, GA
  • NPI 1730796111
  NPD

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

{
    "created_epoch": "1456876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456876800000",
    "number": "1477913580",
    "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": "229-236-0831",
            "fax_number": "229-236-0871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 S MAIN ST STE 103",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313134354",
            "telephone_number": "912-369-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND OPTIM JENKINS EMERGENCY MEDICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-02",
        "last_updated": "2016-03-02",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "229-520-7115",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA Southland Liberty Emergency Medical Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kimberly Ann Speese, RBT, CNA
• Amya Spencer
• Taneeka Spencer

• Emergency Medicine Physician in Hinesville, GA
• Providers in Hinesville, GA by specialty
• Emergency Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2016; 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.