Healthcare Provider Details

I. General information

NPI: 1356093108
Provider Name (Legal Business Name): JMITCHELL TRANSPORTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4991 WATERFORD DR SW
MABLETON GA
30126-1736
US

IV. Provider business mailing address

4991 WATERFORD DR SW
MABLETON GA
30126-1736
US

V. Phone/Fax

Practice location:
  • Phone: 678-313-7096
  • Fax:
Mailing address:
  • Phone: 678-313-7096
  • 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: MR. TOMMIE G MITCHELL SR.
Title or Position: OPERATOR
Credential:
Phone: 678-313-7096