Healthcare Provider Details

I. General information

NPI: 1538072335
Provider Name (Legal Business Name): EDEN EXPRESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 KINNETT DR SW
LILBURN GA
30047-5710
US

IV. Provider business mailing address

2626 KINNETT DR SW
LILBURN GA
30047-5710
US

V. Phone/Fax

Practice location:
  • Phone: 470-469-4233
  • Fax:
Mailing address:
  • Phone: 470-469-4233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: EDEN BOGALE
Title or Position: OWNER
Credential:
Phone: 470-469-4233