Healthcare Provider Details

I. General information

NPI: 1508020637
Provider Name (Legal Business Name): KINGSHIP TRANSPORTATION LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WESTFIELD DR
WARNER ROBINS GA
31093-3718
US

IV. Provider business mailing address

300 WESTFIELD DR
WARNER ROBINS GA
31093-3718
US

V. Phone/Fax

Practice location:
  • Phone: 478-953-1792
  • Fax: 478-953-1792
Mailing address:
  • Phone: 478-953-1792
  • Fax: 478-953-1792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateGA

VIII. Authorized Official

Name: MRS. WANDA DENISE LYONS
Title or Position: OWNER
Credential:
Phone: 478-953-1792