Healthcare Provider Details

I. General information

NPI: 1790064053
Provider Name (Legal Business Name): T.L.C.TRANSPORTATION.ORG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 PEACHTREE ST 400
ATLANTA GA
30361-3503
US

IV. Provider business mailing address

1201 PEACHTREE ST 400
ATLANTA GA
30361-3503
US

V. Phone/Fax

Practice location:
  • Phone: 678-620-9580
  • Fax:
Mailing address:
  • Phone: 678-620-9580
  • Fax:

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: LAURITA CLEMONS
Title or Position: OWNER
Credential: CNA
Phone: 678-620-9580