Healthcare Provider Details

I. General information

NPI: 1366226102
Provider Name (Legal Business Name): TMD DIVERSE TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 SAVANNAH CT
BYRON GA
31008-6451
US

IV. Provider business mailing address

129 SAVANNAH CT
BYRON GA
31008-6451
US

V. Phone/Fax

Practice location:
  • Phone: 229-886-7141
  • Fax:
Mailing address:
  • Phone: 229-886-7141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMALA JONES
Title or Position: ORGANIZER
Credential:
Phone: 229-886-7141