Healthcare Provider Details

I. General information

NPI: 1629355714
Provider Name (Legal Business Name): JET3-TRANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 ATLANTA INDUSTRIAL PKWY NW 204
ATLANTA GA
30331-1045
US

IV. Provider business mailing address

165 LOST COVE DR SW
ATLANTA GA
30331-7535
US

V. Phone/Fax

Practice location:
  • Phone: 678-744-5383
  • Fax:
Mailing address:
  • Phone: 205-587-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number1501017292
License Number StateGA

VIII. Authorized Official

Name: JERRIMICA L MOORE
Title or Position: OWNER
Credential:
Phone: 205-587-9225