MEDICARE: B-LINE MOBILITY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1487586392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B-LINE MOBILITY LLC

Provider Business Mailing Address
First Line	:	1951 OAK VILLAGE LN
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-2927
Country	:	US
Telephone Number	:	470-643-2469
Fax Number	:

Provider Business Practice Location Address
First Line	:	1951 OAK VILLAGE LN
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-2927
Country	:	US
Telephone Number	:	470-643-2469
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ORGANIZER
Name	:	BRUCE WADDELL
Credential	:
Telephone Number	:	470-643-2469

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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