Provider Demographics
NPI:1174069959
Name:WASHINGTON COUNTY EMERGENCY MEDICINE GROUP, LLC
Entity type:Organization
Organization Name:WASHINGTON COUNTY EMERGENCY MEDICINE GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FISCAL SERVICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-240-2102
Mailing Address - Street 1:610 SPARTA RD
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-1860
Mailing Address - Country:US
Mailing Address - Phone:478-240-2000
Mailing Address - Fax:478-240-2377
Practice Address - Street 1:610 SPARTA RD
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1860
Practice Address - Country:US
Practice Address - Phone:478-240-2000
Practice Address - Fax:478-240-2377
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL AUTHORITY OF WASHINGTON COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17000094207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty