Healthcare Provider Details

I. General information

NPI: 1952267205
Provider Name (Legal Business Name): GOLDEN AGE TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PROMINENCE POINT PKWY
CANTON GA
30114-6931
US

IV. Provider business mailing address

300 PROMINENCE POINT PKWY
CANTON GA
30114-6931
US

V. Phone/Fax

Practice location:
  • Phone: 404-637-1717
  • Fax:
Mailing address:
  • Phone: 404-637-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROUL PERRY
Title or Position: CEO
Credential:
Phone: 267-779-7771