Provider Demographics
NPI:1316064629
Name:GEORGIA EMERGENCY MEDICINE SPECIALISTS, PC
Entity type:Organization
Organization Name:GEORGIA EMERGENCY MEDICINE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTDORFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-340-2138
Mailing Address - Street 1:7982 MACON HWY
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-2044
Mailing Address - Country:US
Mailing Address - Phone:706-475-7000
Mailing Address - Fax:
Practice Address - Street 1:1199 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2797
Practice Address - Country:US
Practice Address - Phone:706-475-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10037058OtherAMERIGROUP
GA10037058OtherAMERIGROUP
GA10037058OtherAMERIGROUP