MEDICARE: CANDJ TRANSPORTATIONLLC

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	172A00000X	Driver

General Provider Information

NPI Number	:	1790539419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANDJ TRANSPORTATIONLLC

Provider Business Mailing Address
First Line	:	23 BALL PARK LN
Second Line	:
City	:	CHESTERFIELD
State	:	SC
Zip	:	29709-6180
Country	:	US
Telephone Number	:	843-622-4691
Fax Number	:	843-622-4691

Provider Business Practice Location Address
First Line	:	23 BALL PARK LN
Second Line	:
City	:	CHESTERFIELD
State	:	SC
Zip	:	29709-6180
Country	:	US
Telephone Number	:	843-622-4691
Fax Number	:	843-622-4691

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CONNIE RATLIFF MCBRIDE
Credential	:
Telephone Number	:	843-622-4691

Provider Enumeration Date	:	04/17/2024
Last Update Date	:	04/17/2024

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Directions to “CANDJ TRANSPORTATIONLLC ” Practice Location

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