Healthcare Provider Details

I. General information

NPI: 1134531684
Provider Name (Legal Business Name): LIFEPOINTE MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4191 GRAY HWY
GRAY GA
31032-6101
US

IV. Provider business mailing address

PO BOX 1654
GRAY GA
31032-1654
US

V. Phone/Fax

Practice location:
  • Phone: 229-402-1411
  • Fax: 478-216-2015
Mailing address:
  • Phone: 229-402-1411
  • Fax: 478-216-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateGA

VIII. Authorized Official

Name: MR. CHARLES ALEXANDER KEMP II
Title or Position: MEMBER
Credential: M.B.A.
Phone: 229-402-1411