Healthcare Provider Details

I. General information

NPI: 1386579928
Provider Name (Legal Business Name): WELLGO MEDICAL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 OLD SAYBROOK CT
STONE MOUNTAIN GA
30083-2633
US

IV. Provider business mailing address

2437 IVEY CREST CIR
TUCKER GA
30084-3756
US

V. Phone/Fax

Practice location:
  • Phone: 610-739-9430
  • Fax: 610-739-9430
Mailing address:
  • Phone: 610-739-9430
  • 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: GIRUM WOLDEMARIAM
Title or Position: OPERATIONAL MANAGER
Credential:
Phone: 610-739-9430