Healthcare Provider Details

I. General information

NPI: 1649934555
Provider Name (Legal Business Name): LUXURY NEMT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7247 CONFEDERATE LN
VILLA RICA GA
30180-9614
US

IV. Provider business mailing address

7247 CONFEDERATE LN
VILLA RICA GA
30180-9614
US

V. Phone/Fax

Practice location:
  • Phone: 770-802-0847
  • Fax:
Mailing address:
  • Phone: 770-802-0847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: LASHANNON MARIE NORTH
Title or Position: OWNER
Credential:
Phone: 678-895-0071