Healthcare Provider Details

I. General information

NPI: 1255147567
Provider Name (Legal Business Name): KING REDD TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 SAGE DR
WARNER ROBINS GA
31088-2936
US

IV. Provider business mailing address

212 SAGE DR
WARNER ROBINS GA
31088-2936
US

V. Phone/Fax

Practice location:
  • Phone: 478-302-6861
  • Fax:
Mailing address:
  • Phone: 478-302-6861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. TRACY REDD
Title or Position: EPLOYEE/DRIVER
Credential:
Phone: 857-237-2041