| Southland Emergency Medical Services Consolidated, Llc | |
|
145 E Peacock St Cochran GA 31014-7846 | |
| (478) 934-6211 | |
| Not Available |
| Full Name | Southland Emergency Medical Services Consolidated, Llc |
|---|---|
| Speciality | Hospitalist |
| Location | 145 E Peacock St, Cochran, Georgia |
| Authorized Official Name and Position | Stephanie Fletcher (CFO) |
| Authorized Official Contact | 2922360831 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southland Emergency Medical Services Consolidated, Llc Po Box 102545 Atlanta GA 30368-2545 Ph: () - | Southland Emergency Medical Services Consolidated, Llc 145 E Peacock St Cochran GA 31014-7846 Ph: (478) 934-6211 |
| NPI Number | 1033464391 |
|---|---|
| Provider Enumeration Date | 07/23/2012 |
| Last Update Date | 05/28/2019 |
| Medicare PECOS PAC ID | 4183871320 |
|---|---|
| Medicare Enrollment ID | O20120823000503 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033464391 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208M00000X | Hospitalist | (* (Not Available)) | Primary |
| Provider Name | Dwayne L Watkins |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174543276 PECOS PAC ID: 4981518529 Enrollment ID: I20031118000082 |
| Provider Name | Julie J Sapp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942208111 PECOS PAC ID: 5496659849 Enrollment ID: I20031126000267 |
| Provider Name | Eddie Richardson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235107772 PECOS PAC ID: 1052213311 Enrollment ID: I20040126000779 |
| Provider Name | Troy E Johnson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1285611053 PECOS PAC ID: 4385537844 Enrollment ID: I20040206000750 |
| Provider Name | Sam G Amporful |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013924695 PECOS PAC ID: 6406743806 Enrollment ID: I20040301001111 |
| Provider Name | Brent W Davidson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104874197 PECOS PAC ID: 7719874544 Enrollment ID: I20040304000385 |
| Provider Name | Catherine K Dickens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770670259 PECOS PAC ID: 3577451012 Enrollment ID: I20040308000374 |
| Provider Name | Kirkland T Dodson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689745960 PECOS PAC ID: 4587556956 Enrollment ID: I20040329001333 |
| Provider Name | Carl Lift |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386890697 PECOS PAC ID: 8224920533 Enrollment ID: I20040329001734 |
| Provider Name | Lewis D Friedlander |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1902941685 PECOS PAC ID: 7315935350 Enrollment ID: I20040506000266 |
| Provider Name | David L Hatmaker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578540340 PECOS PAC ID: 7810987948 Enrollment ID: I20040512001174 |
| Provider Name | Vijay K Mahathre |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528047016 PECOS PAC ID: 8527059005 Enrollment ID: I20040522000167 |
| Provider Name | Thomas Campen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497729834 PECOS PAC ID: 0547251944 Enrollment ID: I20040524000764 |
| Provider Name | Robert K Graham |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1871690271 PECOS PAC ID: 0547242745 Enrollment ID: I20040602000788 |
| Provider Name | Michael D Mudrey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376574863 PECOS PAC ID: 0042292120 Enrollment ID: I20040602001450 |
| Provider Name | Leonard F Howard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841227923 PECOS PAC ID: 0244212207 Enrollment ID: I20040603000361 |
| Provider Name | William C Cirillo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831291228 PECOS PAC ID: 5092790089 Enrollment ID: I20040623000568 |
| Provider Name | Rodney E Moore |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669420261 PECOS PAC ID: 6800874231 Enrollment ID: I20040712000510 |
| Provider Name | Theodore L Yarboro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114979499 PECOS PAC ID: 9830177146 Enrollment ID: I20040713000372 |
| Provider Name | Sidney Joseph Morgan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205879301 PECOS PAC ID: 4082693098 Enrollment ID: I20040714001036 |
| Provider Name | Jean Paul Landry |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1356304844 PECOS PAC ID: 4183603004 Enrollment ID: I20040715000263 |
| Provider Name | Johnathan R Gore |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1922027283 PECOS PAC ID: 5294705968 Enrollment ID: I20040730000856 |
| Provider Name | James V Robertson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801985676 PECOS PAC ID: 1052383163 Enrollment ID: I20040810000372 |
| Provider Name | Julius B Oderinde |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356437040 PECOS PAC ID: 0749252484 Enrollment ID: I20040812000003 |
| Provider Name | Fatisha Enahora E Gayton |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1508979097 PECOS PAC ID: 4183698152 Enrollment ID: I20040825000061 |
| Provider Name | Armando R Castillo |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1972540060 PECOS PAC ID: 2163481029 Enrollment ID: I20041006000796 |
| Provider Name | Helen E Carrington |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1295762169 PECOS PAC ID: 5991754434 Enrollment ID: I20050121000473 |
| Provider Name | Heather Dawn Hall |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154387579 PECOS PAC ID: 6204883432 Enrollment ID: I20050331000259 |
| Provider Name | Bernard F Oddi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245270727 PECOS PAC ID: 6305888264 Enrollment ID: I20050601000720 |
| Provider Name | Paul C Conrad |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316982911 PECOS PAC ID: 2860461746 Enrollment ID: I20050623000031 |
| Provider Name | Marshall G Tanner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326031865 PECOS PAC ID: 6305879990 Enrollment ID: I20050914000752 |
| Provider Name | Marshall K Hinds |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780792911 PECOS PAC ID: 9335164862 Enrollment ID: I20051013000193 |
| Provider Name | Akinlolu A Omitowoju |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760497317 PECOS PAC ID: 7911927470 Enrollment ID: I20051129000492 |
| Provider Name | Johnathan E Gaskins |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528169190 PECOS PAC ID: 0446272587 Enrollment ID: I20060103000676 |
| Provider Name | Michael R Nulph |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851332787 PECOS PAC ID: 0941210090 Enrollment ID: I20060504000477 |
| Provider Name | Lawrence F Kulish |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1467437913 PECOS PAC ID: 3375455512 Enrollment ID: I20060817000364 |
| Provider Name | Jairaj Goberdhan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194760744 PECOS PAC ID: 1759385412 Enrollment ID: I20060912000048 |
| Provider Name | William O Rankine |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770540916 PECOS PAC ID: 8426053778 Enrollment ID: I20060920000444 |
| Provider Name | John H Washington |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083627442 PECOS PAC ID: 5496750242 Enrollment ID: I20060929000007 |
| Provider Name | Dennis R Spencer |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1386723310 PECOS PAC ID: 8325048895 Enrollment ID: I20070106000016 |
| Provider Name | Jeffrey S Reed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427146125 PECOS PAC ID: 5799785275 Enrollment ID: I20070106000123 |
| Provider Name | Paul E Raber |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740394428 PECOS PAC ID: 0547262792 Enrollment ID: I20070201000218 |
| Provider Name | Perry M Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922168103 PECOS PAC ID: 3173525672 Enrollment ID: I20070213000553 |
| Provider Name | William Reid |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1912922279 PECOS PAC ID: 5991754673 Enrollment ID: I20070723000039 |
| Provider Name | Jonathan Steven Williams |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346391299 PECOS PAC ID: 6507954799 Enrollment ID: I20071126000151 |
| Provider Name | Larry R Smith |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1619953569 PECOS PAC ID: 1557443355 Enrollment ID: I20080201000332 |
| Provider Name | Mark Lee |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1619028255 PECOS PAC ID: 7113004524 Enrollment ID: I20080409000740 |
| Provider Name | Jay J Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407823859 PECOS PAC ID: 3375649718 Enrollment ID: I20080422000466 |
| Provider Name | Louis J Perino |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1326076373 PECOS PAC ID: 1951469741 Enrollment ID: I20081023000202 |
| Provider Name | Brian L Gretta |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1659356384 PECOS PAC ID: 1456384478 Enrollment ID: I20090720000016 |
| Provider Name | Daren K Wooten |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1811194483 PECOS PAC ID: 3375695273 Enrollment ID: I20090723000042 |
| Provider Name | Michael B Sumner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528250388 PECOS PAC ID: 7315085107 Enrollment ID: I20091116000540 |
| Provider Name | Charles A Hughes |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1720053598 PECOS PAC ID: 2567506587 Enrollment ID: I20100215000323 |
| Provider Name | Ian James Davis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902003395 PECOS PAC ID: 6901930015 Enrollment ID: I20100811000542 |
| Provider Name | Stephen W Jarrard |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1649439134 PECOS PAC ID: 9638363815 Enrollment ID: I20101102000024 |
| Provider Name | Viktoria Nurpeisov |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699923169 PECOS PAC ID: 4981890951 Enrollment ID: I20101204000020 |
| Provider Name | Tian Xia |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1437357423 PECOS PAC ID: 2961681713 Enrollment ID: I20110125001006 |
| Provider Name | Ike A Nwaobi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1417112475 PECOS PAC ID: 8224218391 Enrollment ID: I20110207000356 |
| Provider Name | Ray Thomas Ross |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1508940651 PECOS PAC ID: 6406955889 Enrollment ID: I20110310000169 |
| Provider Name | Laneau Hayes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235134669 PECOS PAC ID: 7315967338 Enrollment ID: I20110314000961 |
| Provider Name | Eric J Zanghi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336182567 PECOS PAC ID: 7012194129 Enrollment ID: I20110526000592 |
| Provider Name | Atul M Devani |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053571117 PECOS PAC ID: 0446421341 Enrollment ID: I20110927000019 |
| Provider Name | Dingane Baruti |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215945969 PECOS PAC ID: 4486826286 Enrollment ID: I20111019000841 |
| Provider Name | Perry R Hearn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568412146 PECOS PAC ID: 2466429543 Enrollment ID: I20120802000398 |
| Provider Name | Nariel C Offomah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851380489 PECOS PAC ID: 5799758983 Enrollment ID: I20121128000528 |
| Provider Name | Matthew Davis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295172773 PECOS PAC ID: 3274773171 Enrollment ID: I20130716000869 |
| Provider Name | Fanta E Kasiah |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639480684 PECOS PAC ID: 8729227178 Enrollment ID: I20130909000461 |
| Provider Name | Luis Ramos Santiago |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1639147531 PECOS PAC ID: 7012915879 Enrollment ID: I20140310002037 |
| Provider Name | Moshe M Usadi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1629154554 PECOS PAC ID: 3476644543 Enrollment ID: I20140624002014 |
| Provider Name | Michael S Coulthard |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1700172707 PECOS PAC ID: 0749416121 Enrollment ID: I20140905000551 |
| Provider Name | Jacqueline Tobey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821404070 PECOS PAC ID: 2163643222 Enrollment ID: I20141015001196 |
| Provider Name | Ashley E Traylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962819482 PECOS PAC ID: 9830310622 Enrollment ID: I20141020002002 |
| Provider Name | Wila Zanghi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518374537 PECOS PAC ID: 2769704485 Enrollment ID: I20150126000523 |
| Provider Name | Kyle Lendl Jones |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1871881771 PECOS PAC ID: 4183946254 Enrollment ID: I20150625002651 |
| Provider Name | Wael Azer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1841588241 PECOS PAC ID: 5991017840 Enrollment ID: I20150706002543 |
| Provider Name | Jeremy Garrard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386871895 PECOS PAC ID: 2365674645 Enrollment ID: I20150817001118 |
| Provider Name | James R Kisselburg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841434255 PECOS PAC ID: 0648496687 Enrollment ID: I20161004003046 |
| Provider Name | Billy Joe Pitts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306396254 PECOS PAC ID: 2466730122 Enrollment ID: I20161031002159 |
| Provider Name | Kristin Seals Benefield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437692381 PECOS PAC ID: 4486938453 Enrollment ID: I20170313000625 |
| Provider Name | William C Arnett |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1255627246 PECOS PAC ID: 2466771878 Enrollment ID: I20170403000235 |
| Provider Name | Justin Law |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962750323 PECOS PAC ID: 1456343730 Enrollment ID: I20170404002559 |
| Provider Name | Daniel F Jung |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1942434535 PECOS PAC ID: 6507038742 Enrollment ID: I20170530000286 |
| Provider Name | Dawn M Vanover |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508392325 PECOS PAC ID: 2264709864 Enrollment ID: I20170602001444 |
| Provider Name | Thang Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164657821 PECOS PAC ID: 8820263130 Enrollment ID: I20180710002898 |
| Provider Name | Pranam Kokilakumar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376938696 PECOS PAC ID: 2567746274 Enrollment ID: I20180905003725 |
| Provider Name | Amy Queen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275026072 PECOS PAC ID: 3173874682 Enrollment ID: I20180922000068 |
| Provider Name | Melissa Denise Masuicca |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972080364 PECOS PAC ID: 6901150051 Enrollment ID: I20181108002278 |
| Provider Name | Mary K Ward |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538639851 PECOS PAC ID: 4082952999 Enrollment ID: I20190218002586 |
| Provider Name | Nicholas T Herga |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1134581705 PECOS PAC ID: 5890080758 Enrollment ID: I20190618002427 |
| Provider Name | James B Cox |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083966709 PECOS PAC ID: 6709166168 Enrollment ID: I20190722000776 |
| Provider Name | Carolyn Joy Fletcher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679073464 PECOS PAC ID: 9537495858 Enrollment ID: I20190724003327 |
| Provider Name | Bhargav Sai Charan Marthambadi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124475595 PECOS PAC ID: 5193081784 Enrollment ID: I20190827002545 |
| Provider Name | Teresa Eden Jabaley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982146973 PECOS PAC ID: 7416232111 Enrollment ID: I20190905002124 |
| Provider Name | Katherine Kendrick |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780117416 PECOS PAC ID: 8426312141 Enrollment ID: I20191105003173 |
| Provider Name | James William Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851935316 PECOS PAC ID: 2567897424 Enrollment ID: I20200122003356 |
| Provider Name | Ugo A Ireh |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1750324026 PECOS PAC ID: 2769580554 Enrollment ID: I20200213000380 |
| Provider Name | Jerrid A Pippin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477811370 PECOS PAC ID: 2961723713 Enrollment ID: I20200214002109 |
| Provider Name | Neeraja Chandrasekaran |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1124442181 PECOS PAC ID: 7810325933 Enrollment ID: I20200323002825 |
| Provider Name | Inder Paul Singh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235260696 PECOS PAC ID: 0840378550 Enrollment ID: I20200515001500 |
| Provider Name | Francis Ogbobe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578910378 PECOS PAC ID: 4981938644 Enrollment ID: I20200925002251 |
| Provider Name | Kenneth James Burnsed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730796111 PECOS PAC ID: 9830165844 Enrollment ID: I20201029000948 |
| Provider Name | John P Cooper |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1366973786 PECOS PAC ID: 2163794207 Enrollment ID: I20201121000218 |
| Provider Name | Chad D Tarr |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1598717639 PECOS PAC ID: 3072541978 Enrollment ID: I20201229002396 |
| Provider Name | Joushua Bailey |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780078907 PECOS PAC ID: 4789973736 Enrollment ID: I20210128001882 |
| Provider Name | Jordan Simpson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871158840 PECOS PAC ID: 4486980901 Enrollment ID: I20210226000550 |
| Provider Name | Jillian Soto |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1912499286 PECOS PAC ID: 6709136351 Enrollment ID: I20210226000983 |
| Provider Name | Esther Amprofi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912529819 PECOS PAC ID: 7618399064 Enrollment ID: I20210226001377 |
| Provider Name | Nateka Latrice Austin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558922096 PECOS PAC ID: 4587090576 Enrollment ID: I20210504001205 |
| Provider Name | Kevin Summers |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124550934 PECOS PAC ID: 3173947207 Enrollment ID: I20210521000042 |
| Provider Name | Robert Daniel Maner |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1417488925 PECOS PAC ID: 9234403981 Enrollment ID: I20210716000207 |
| Provider Name | Bader Nizar Kashlan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336680560 PECOS PAC ID: 1658642236 Enrollment ID: I20210812000443 |
| Provider Name | Nicholas Benjamin Clemmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881357127 PECOS PAC ID: 7810386190 Enrollment ID: I20211108000096 |
| Provider Name | Aaron-nickolaos Zervos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174086110 PECOS PAC ID: 8921498890 Enrollment ID: I20211208001277 |
| Provider Name | Dawn Coull |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063186518 PECOS PAC ID: 4880090422 Enrollment ID: I20211228000221 |
| Provider Name | Brittni Ruble |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588289177 PECOS PAC ID: 3274958418 Enrollment ID: I20220210000249 |
| Provider Name | Shametrial Glascock Foreman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144795618 PECOS PAC ID: 0840683728 Enrollment ID: I20220217001662 |
| Provider Name | Tron L Bullard |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1326663642 PECOS PAC ID: 5597152603 Enrollment ID: I20220420000331 |
| Provider Name | Jina Kiele Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609525492 PECOS PAC ID: 9335536267 Enrollment ID: I20220425001023 |
| Provider Name | Kelsey L Stanford |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992277354 PECOS PAC ID: 2567851645 Enrollment ID: I20220808001437 |
| Provider Name | Michael Anthony Sonntag |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831765478 PECOS PAC ID: 0143603332 Enrollment ID: I20220822000978 |
| Provider Name | Joel Tumaliuan Moats |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396477808 PECOS PAC ID: 1456735851 Enrollment ID: I20220902002292 |
| Provider Name | Jonathan David Rivers |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1265057590 PECOS PAC ID: 9739506643 Enrollment ID: I20220928000235 |
| Provider Name | Stacey Joanne Tapley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972238772 PECOS PAC ID: 6901272095 Enrollment ID: I20221013003540 |
| Provider Name | Juan S Serna-gonzalez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700402013 PECOS PAC ID: 0446615306 Enrollment ID: I20230427001475 |
| Provider Name | Jimmy Andrew Sellers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215631981 PECOS PAC ID: 5799142261 Enrollment ID: I20230530000626 |
| Provider Name | Ronald Sean Demeyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548958648 PECOS PAC ID: 1254792146 Enrollment ID: I20230725000660 |
| Provider Name | Taylor Payne |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609491950 PECOS PAC ID: 9335562230 Enrollment ID: I20231113001006 |
| Provider Name | Stacie D. Buckley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265297873 PECOS PAC ID: 8729427323 Enrollment ID: I20240416001055 |
| Provider Name | Mathew Scott |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1336602325 PECOS PAC ID: 9537498001 Enrollment ID: I20240502000337 |
| Provider Name | Christopher Brian Rowley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194266122 PECOS PAC ID: 1658751383 Enrollment ID: I20240506003337 |
Fasttrack Immediate Care, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 126 N 2nd St, Cochran, GA 31014 Phone: 478-271-0337 Fax: 478-295-3003 | |
Cochran Family Healthcare Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 145 E Peacock St Ste 3, Cochran, GA 31014 Phone: 478-934-9714 | |
Careconnect Family Practice Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 109 S 3rd St, Cochran, GA 31014 Phone: 478-934-4988 Fax: 478-934-4989 | |
Middle Georgia State University Sports Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1100 2nd St Se, Cochran, GA 31014 Phone: 972-367-4845 Fax: 972-367-3451 | |
Taylor Physicians Practice # 23 Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 136 W Dykes St, Cochran, GA 31014 Phone: 478-271-0200 Fax: 478-934-8887 | |
Taylor Physicians Practice # 26 Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 150 E Peacock St, Ste B, Cochran, GA 31014 Phone: 478-934-6926 Fax: 478-934-8887 |