Healthcare Provider Details

I. General information

NPI: 1487457701
Provider Name (Legal Business Name): XTRA CARE TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 WINSHIRE CV
ALPHARETTA GA
30004-0691
US

IV. Provider business mailing address

1620 WINSHIRE CV
ALPHARETTA GA
30004-0691
US

V. Phone/Fax

Practice location:
  • Phone: 470-258-8114
  • Fax:
Mailing address:
  • Phone: 470-258-8114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: SHARNESE JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 470-258-8114