Healthcare Provider Details

I. General information

NPI: 1790078103
Provider Name (Legal Business Name): SUMMIT ONE BUSINESS GROUP L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13085 MORRIS RD #11101
ALPHARETTA GA
30004-4155
US

IV. Provider business mailing address

13085 MORRIS RD #11101
ALPHARETTA GA
30004-4155
US

V. Phone/Fax

Practice location:
  • Phone: 678-624-1795
  • Fax:
Mailing address:
  • Phone: 678-624-1795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MR. WARD ALLEN STRIGGLES JR.
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 678-624-1795