Healthcare Provider Details

I. General information

NPI: 1609187061
Provider Name (Legal Business Name): A MUTUAL DESTINY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 VETERANS PKWY SUITE 1-C
COLUMBUS GA
31909-3169
US

IV. Provider business mailing address

6501 VETERANS PKWY SUITE 1-C
COLUMBUS GA
31909-3169
US

V. Phone/Fax

Practice location:
  • Phone: 706-289-9740
  • Fax: 706-660-9989
Mailing address:
  • Phone: 706-289-9740
  • Fax: 706-660-9989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number09072060
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number09072060
License Number StateGA

VIII. Authorized Official

Name: MS. JEWEL L HARRIS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 706-289-9740