NPIMap

Organization Active NPI

Southland Hawkinsville Emergency Medical Services, LLC

  • Emergency Medicine Physician
  • Hawkinsville, GA
National Provider Identifier
1891100962
Registry record updated Jun 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
SOUTHLAND HAWKINSVILLE EMERGENCY MEDICAL SERVICES, LLC
Practice address
222 Perry Hwy
Hawkinsville, GA 31036
Phone
(478) 783-0200
NPI assigned
Jun 26, 2014
Last updated
Jun 28, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2018

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

Authorized official

Name
Dr. Mark Lee, MDNPI 1619028255
Title
Ceo
Phone
(229) 236-0831

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

222 Perry Hwy
Hawkinsville, GA 31036

Mailing address

PO Box 102545
Atlanta, GA 30368-2545

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140908000486 GA Part B Supplier - Clinic/Group Practice 2769600642 Receives reassigned benefits from 25 practitioners
Practice locations: Hawkinsville, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1403740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530144000000",
    "number": "1891100962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102545",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303682545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 PERRY HWY",
            "city": "HAWKINSVILLE",
            "state": "GA",
            "postal_code": "31036",
            "telephone_number": "478-783-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND HAWKINSVILLE EMERGENCY MEDICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-26",
        "last_updated": "2018-06-28",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "229-236-0831",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hawkinsville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2018; 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.