Provider Demographics
NPI:1699147421
Name:GEORGIA EMERGENCY ASSOCIATES IMMEDIATE CARE CENTER
Entity type:Organization
Organization Name:GEORGIA EMERGENCY ASSOCIATES IMMEDIATE CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-295-5860
Mailing Address - Street 1:5629 HWY 21 S
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-9416
Mailing Address - Country:US
Mailing Address - Phone:912-295-5860
Mailing Address - Fax:912-295-5924
Practice Address - Street 1:3 PROGRESSIVE ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5165
Practice Address - Country:US
Practice Address - Phone:843-815-9119
Practice Address - Fax:843-815-9121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty