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General NPI Number Information
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NPI Number | 1073906996
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Entity Type | Organization
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Legal Business Name | SOUTHERN CUSTOMZ LLC
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 390 ROBIN WAY
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City | EAST DUBLIN
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State | GA
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Zip | 31027-1694
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Country | US
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Telephone | 470-217-5857
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Fax | 478-304-1254
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Provider Business Mailing Address
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Address Line | 390 ROBIN WAY
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City | EAST DUBLIN
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State | GA
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Zip | 31027-1694
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Country | US
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Telephone | 470-217-5857
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Fax | 478-304-1254
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Authorized Official
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Title or Position | CEO
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Name | JOHNARD MCLENDON
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Credential |
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Telephone | 470-217-5857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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