Healthcare Provider Details

I. General information

NPI: 1457772600
Provider Name (Legal Business Name): REPUBLIK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 PYLANT ST NE
ATLANTA GA
30306-3728
US

IV. Provider business mailing address

695 PYLANT ST NE
ATLANTA GA
30306-3728
US

V. Phone/Fax

Practice location:
  • Phone: 404-721-2324
  • Fax: 404-393-4045
Mailing address:
  • Phone: 404-721-2324
  • Fax: 404-393-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER MARTELL TYLER
Title or Position: OPERATION MANAGER
Credential: MBA
Phone: 404-721-2324