| Organization Name: | PEACH STATE EMS, LLC |
| NPI Number: | 1184037616 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEVIN RAY STANCLIFF (OWNER) |
| Mailing Address: | 11335 Lewis Braselton Blvd Suite 110 Braselton |
| State: | GA US |
| Postal Code: | 305173288 |
| Phone Number: | 8888381391 |
| Fax Number: | 8883918501 |
| NPI Enumeration Date: | 06/02/2014 |
| NPI Last Update Date: | 11/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3416L0300X |
| License Number: | 078-04 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Ambulance |
| Taxonomy Specialization: | Land Transport |
| Taxonomy Definition: | |