Healthcare Provider Details

I. General information

NPI: 1871301945
Provider Name (Legal Business Name): MY MOBILITY RIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 MAIN ST E STE B142
SNELLVILLE GA
30078-6463
US

IV. Provider business mailing address

PO BOX 83012
CONYERS GA
30013-8014
US

V. Phone/Fax

Practice location:
  • Phone: 678-255-5195
  • Fax:
Mailing address:
  • Phone: 678-255-5195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. JANICE BRYANT
Title or Position: PRESIDENT
Credential:
Phone: 678-255-5195