NPIMap

Organization Active NPI

Georgia Emergency Department Services, P.C.

  • Emergency Medicine Physician
  • Gainesville, GA
National Provider Identifier
1508886912
Registry record updated Mar 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
GEORGIA EMERGENCY DEPARTMENT SERVICES, P.C.
Practice address
743 Spring St NE
Gainesville, GA 30501-3715
Phone
(770) 536-2146
NPI assigned
Jul 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2024

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

Authorized official

Name
Georgia Emergency de Georgia Emergency Department Servic
Title
Ops Manager
Phone
(808) 294-0714

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

743 Spring St NE
Gainesville, GA 30501-3715

Mailing address

PO Box 3387
Indianapolis, IN 46206-3387
Phone (866) 863-6635

Other practice location 1

541 Historic Hwy #441 N
Demorest, GA 30535
Phone (706) 754-2161

Other practice location 2

227 Mountain Dr
Dahlonega, GA 30533-1606
Phone (770) 219-9000

Other practice location 3

162 Legacy Pt
Clayton, GA 30525-5354
Phone (706) 782-3100

Other practice location 4

1400 River Pl
Braselton, GA 30517-5600
Phone (770) 848-8000

Other practice location 5

316 N Broad St
Winder, GA 30680-2150
Phone (770) 867-3400

Other identifiers 1

IdentifierTypeStateIssuer
CH6759OtherGARAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040517001016 GA Part B Supplier - Clinic/Group Practice 5597751032 Receives reassigned benefits from 109 practitioners
Practice locations: Gainesville, GA; Winder, GA; Madison, GA; Demorest, GA; Dahlonega, GA; Braselton, GA

National Provider Directory

National Provider Directory

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 137

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

View all 137

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711584000000",
    "number": "1508886912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3387",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462063387",
            "telephone_number": "866-863-6635",
            "fax_number": "855-269-9731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "743 SPRING ST NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013715",
            "telephone_number": "770-536-2146"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "541 Historic Hwy #441 N",
            "address_purpose": "LOCATION",
            "city": "Demorest",
            "state": "GA",
            "postal_code": "30535",
            "country_code": "US",
            "telephone_number": "706-754-2161",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "227 Mountain Dr",
            "address_purpose": "LOCATION",
            "city": "Dahlonega",
            "state": "GA",
            "postal_code": "305331606",
            "country_code": "US",
            "telephone_number": "770-219-9000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "162 Legacy Pt",
            "address_purpose": "LOCATION",
            "city": "Clayton",
            "state": "GA",
            "postal_code": "305255354",
            "country_code": "US",
            "telephone_number": "706-782-3100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1400 River Pl",
            "address_purpose": "LOCATION",
            "city": "Braselton",
            "state": "GA",
            "postal_code": "305175600",
            "country_code": "US",
            "telephone_number": "770-848-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "316 N Broad St",
            "address_purpose": "LOCATION",
            "city": "Winder",
            "state": "GA",
            "postal_code": "306802150",
            "country_code": "US",
            "telephone_number": "770-867-3400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GEORGIA EMERGENCY DEPARTMENT SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A",
        "authorized_official_last_name": "GEORGIA EMERGENCY DEPARTMENT SERVIC",
        "authorized_official_first_name": "GEORGIA EMERGENCY DE",
        "authorized_official_title_or_position": "OPS MANAGER",
        "authorized_official_telephone_number": "808-294-0714"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH6759",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; 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.