=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124978739
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIZZIE TRANSPORTATION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2026
-----------------------------------------------------
Last Update Date | 02/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2565 LEGEND MILL RUN
-----------------------------------------------------
City | DACULA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30019-6877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-577-2691
-----------------------------------------------------
Fax | 470-567-5815
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2565 LEGEND MILL RUN
-----------------------------------------------------
City | DACULA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30019-6877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-577-2691
-----------------------------------------------------
Fax | 470-567-5815
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. BRUCE A WILKERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 470-577-2691
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172A00000X
-----------------------------------------------------
Taxonomy Name | Driver
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------