GEORGIA EMERGENCY DEPARTMENT SERVICES, P.C. – Emergency Medicine Physician, NPI 1508886912
Emergency Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for GEORGIA EMERGENCY DEPARTMENT SERVICES, P.C.
1400 River Pl
Braselton, GA 305175600
Phone: (770) 848-8000
Type: Location
316 N Broad St
Winder, GA 306802150
Phone: (770) 867-3400
Type: Location
541 Historic Hwy #441 N
Demorest, GA 30535
Phone: (706) 754-2161
Type: Location
227 Mountain Dr
Dahlonega, GA 305331606
Phone: (770) 219-9000
Type: Location
162 Legacy Pt
Clayton, GA 305255354
Phone: (706) 782-3100
Type: Location
Northeast Georgia Medical Center, 743, Spring Street Northeast, Gainesville, Hall County, Georgia, 30501, United States
GAINESVILLE, GA 305013715
Phone: (770) 536-2146
Type: Location
Andrew Jacobs Jr. Post Office, 125, West South Street, Old Southside, Indianapolis, Marion County, Indiana, 46206, United States
INDIANAPOLIS, IN 462063387
Phone: (866) 863-6635
Fax: (855) 269-9731
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-05-17
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040517001016 | O | Clinic/Group Practice | GA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30517)
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