Healthcare Provider Details

I. General information

NPI: 1619652195
Provider Name (Legal Business Name): ECC TRANSPORT SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 KITCHENS RD
WRIGHTSVILLE GA
31096-8000
US

IV. Provider business mailing address

148 KITCHENS RD
WRIGHTSVILLE GA
31096-8000
US

V. Phone/Fax

Practice location:
  • Phone: 478-305-1638
  • Fax:
Mailing address:
  • Phone: 478-305-1638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. RICKY CARNELL CASON
Title or Position: DRIVER
Credential:
Phone: 478-595-2369