Healthcare Provider Details

I. General information

NPI: 1922610476
Provider Name (Legal Business Name): BLOODSTONE AND PEARL TRANSPORTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 MILSTEAD RD NE STE 101
CONYERS GA
30012-3824
US

IV. Provider business mailing address

7002 ANNIE WALK
LITHONIA GA
30038-4675
US

V. Phone/Fax

Practice location:
  • Phone: 470-545-0860
  • Fax:
Mailing address:
  • Phone: 470-545-0860
  • Fax: 470-300-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ELLA MICHELLE STEPHENSON
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 470-545-0860