Healthcare Provider Details

I. General information

NPI: 1811227820
Provider Name (Legal Business Name): SANACO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 CREEKSIDE TRCE
JONESBORO GA
30236-6187
US

IV. Provider business mailing address

2415 CREEKSIDE TRCE
JONESBORO GA
30236-6187
US

V. Phone/Fax

Practice location:
  • Phone: 770-471-4778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number053867095
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number053867095
License Number StateGA

VIII. Authorized Official

Name: SHANECE BELVIN
Title or Position: PRESIDENT
Credential:
Phone: 770-477-4778