Healthcare Provider Details

I. General information

NPI: 1184077695
Provider Name (Legal Business Name): JOHNSON & JOHNSON TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S 1ST ST
UVALDA GA
30473-3156
US

IV. Provider business mailing address

P.O. BOX 251
UVALDA GA
30473-3156
US

V. Phone/Fax

Practice location:
  • Phone: 912-594-1812
  • Fax: 912-594-1817
Mailing address:
  • Phone: 912-594-1812
  • Fax: 912-594-1817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberAMB2016011
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number2858
License Number StateGA

VIII. Authorized Official

Name: MR. JEFFERY JOHNSON
Title or Position: OWNER
Credential:
Phone: 912-253-1159