=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255041844
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ESTER CROWN TRANSPORT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2022
-----------------------------------------------------
Last Update Date | 12/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1471 BEECHWOOD CIR
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30046-8844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-803-2875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1911 GRAYSON HWY STE 8-125
-----------------------------------------------------
City | GRAYSON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30017-1245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-803-2875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER /AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | TAMMY ALISHA WRIGHT
-----------------------------------------------------
Credential | CEO
-----------------------------------------------------
Telephone | 334-803-2875
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------