Healthcare Provider Details

I. General information

NPI: 1265217053
Provider Name (Legal Business Name): MTJ MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GLENLAKE PKWY
ATLANTA GA
30328-3495
US

IV. Provider business mailing address

10 GLENLAKE PKWY
SANDY SPRINGS GA
30328-3495
US

V. Phone/Fax

Practice location:
  • Phone: 770-679-7074
  • Fax:
Mailing address:
  • Phone: 770-679-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
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 Code347B00000X
TaxonomyBus
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MRS. TENISHA CAMPBELL
Title or Position: OWNER
Credential:
Phone: 910-670-0126