NPIMap

Organization Active NPI

Southland Dodge Emergency Medical Services, LLC

  • Emergency Medicine Physician
  • Eastman, GA
National Provider Identifier
1851958607
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 DODGE EMERGENCY MEDICAL SERVICES, LLC
Practice address
901 Griffin Ave
Eastman, GA 31023-6720
Phone
(478) 448-4000
NPI assigned
May 28, 2019
Last updated
Jun 11, 2019By the provider in NPPES
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 Physician 207P00000X NU Primary

Addresses

Primary practice location

901 Griffin Ave
Eastman, GA 31023-6720

Mailing address

PO Box 1276
Thomasville, GA 31799-1276
Phone (229) 236-0831

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191031001338 GA Part B Supplier - Clinic/Group Practice 8224360805 Receives reassigned benefits from 30 practitioners
Practice locations: Eastman, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 30

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 30

NPI Registry JSON

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

{
    "created_epoch": "1559001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1851958607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1276",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317991276",
            "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": "901 GRIFFIN AVE",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310236720",
            "telephone_number": "478-448-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND DODGE EMERGENCY MEDICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-28",
        "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": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eastman, 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.