Healthcare Provider Details

I. General information

NPI: 1124983440
Provider Name (Legal Business Name): AUTHENTIC TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CHATHAM RD APT 212
WINSTON SALEM NC
27101-1255
US

IV. Provider business mailing address

800 CHATHAM RD APT 212
WINSTON SALEM NC
27101-1255
US

V. Phone/Fax

Practice location:
  • Phone: 336-750-7925
  • Fax:
Mailing address:
  • Phone:
  • 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: NICHOLAS DAVIS
Title or Position: OPERATOR
Credential:
Phone: 336-750-7925