Healthcare Provider Details

I. General information

NPI: 1467317560
Provider Name (Legal Business Name): TKD TRUCKING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 OLD CONCORD RD
CHARLOTTE NC
28213-7112
US

IV. Provider business mailing address

5800 OLD CONCORD RD
CHARLOTTE NC
28213-7112
US

V. Phone/Fax

Practice location:
  • Phone: 704-974-2755
  • Fax:
Mailing address:
  • Phone: 704-974-2755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ERNESTINE JACKSON
Title or Position: DIRECTOR
Credential:
Phone: 704-974-2755