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General NPI Number Information
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NPI Number | 1275020430
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Entity Type | Organization
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Legal Business Name | ANN DOUGLAS TRANSPORTATION, LLC
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 376 TAPLEY RD
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City | VILLA RICA
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State | GA
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Zip | 30180-7330
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Country | US
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Telephone | 678-371-9302
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Fax |
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Provider Business Mailing Address
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Address Line | 376 TAPLEY RD
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City | VILLA RICA
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State | GA
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Zip | 30180-7330
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Country | US
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Telephone | 678-371-9302
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Fax |
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Authorized Official
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Title or Position | COPORATE OFFICER
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Name | RANDY DOUGALS JONES
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Credential |
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Telephone | 678-371-9302
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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 | 2018-000528
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License Number State | GA
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