MEDICARE: EZ TRAVEL TRANSPORTATION

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1568174316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EZ TRAVEL TRANSPORTATION

Provider Business Mailing Address
First Line	:	1305 APACHE TRL
Second Line	:
City	:	HEPHZIBAH
State	:	GA
Zip	:	30815-5645
Country	:	US
Telephone Number	:	786-877-5919
Fax Number	:

Provider Business Practice Location Address
First Line	:	1445 WOODMONT LN NW # 1134
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2866
Country	:	US
Telephone Number	:	713-819-6795
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DEBRA JONSON
Credential	:
Telephone Number	:	706-840-8088

Provider Enumeration Date	:	12/22/2022
Last Update Date	:	12/22/2022

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