Healthcare Provider Details

I. General information

NPI: 1619562303
Provider Name (Legal Business Name): GRECO TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ROSE ST STE B
MARTINEZ GA
30907-2391
US

IV. Provider business mailing address

300 ROSE ST
MARTINEZ GA
30907-2391
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-4365
  • Fax:
Mailing address:
  • Phone: 706-364-4365
  • Fax:

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 State

VIII. Authorized Official

Name: KARYN EDMONDSON
Title or Position: PRESIDENT, CEO
Credential:
Phone: 706-364-4365