Healthcare Provider Details

I. General information

NPI: 1205121894
Provider Name (Legal Business Name): DA DIP FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8964 HABERSHAM DR
JONESBORO GA
30238-4446
US

IV. Provider business mailing address

8964 HABERSHAM DR
JONESBORO GA
30238-4446
US

V. Phone/Fax

Practice location:
  • Phone: 504-579-9215
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateGA

VIII. Authorized Official

Name: MR. ERIC HENRY TIMMONS SR.
Title or Position: CEO / PRESIDENT
Credential:
Phone: 504-579-9215