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General NPI Number Information
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NPI Number | 1205539905
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Entity Type | Organization
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Legal Business Name | LIVING WELL TRANSPORTATION SERVICES LLC
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Dates
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Enumeration Date | 03/23/2023
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 10903 WHEELER TRCE
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City | HAMPTON
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State | GA
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Zip | 30228-6461
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Country | US
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Telephone | 678-608-9612
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Fax | 678-829-3499
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Provider Business Mailing Address
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Address Line | 10903 WHEELER TRCE
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City | HAMPTON
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State | GA
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Zip | 30228-6461
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Country | US
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Telephone | 678-608-9612
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANGENETTE YVONNE AGAMA
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Credential |
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Telephone | 678-608-9612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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