Healthcare Provider Details

I. General information

NPI: 1558908111
Provider Name (Legal Business Name): KLB TRANSPORTATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5658 REX RIDGE LOOP
REX GA
30273-5237
US

IV. Provider business mailing address

5658 REX RIDGE LOOP
REX GA
30273-5237
US

V. Phone/Fax

Practice location:
  • Phone: 404-849-9419
  • Fax:
Mailing address:
  • Phone: 404-849-9419
  • Fax: 678-669-2942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KEITH BACKMON
Title or Position: OWMER
Credential:
Phone: 404-849-9419