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General NPI Number Information
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NPI Number | 1285192781
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Entity Type | Organization
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Legal Business Name | PROMED TRANSPORT LLC
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Dates
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Enumeration Date | 03/04/2019
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 1720 LEXINGTON RD STE B
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City | ATHENS
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State | GA
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Zip | 30605-2330
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Country | US
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Telephone | 770-800-8007
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Fax | 770-800-8004
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Provider Business Mailing Address
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Address Line | 182 ROOSEVELT BLVD
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City | COMMERCE
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State | GA
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Zip | 30529-2131
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Country | US
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Telephone | 727-667-0436
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Fax | 770-814-0212
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Authorized Official
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Title or Position | MANAGER MEMBER
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Name | ANITA L DAVOL
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Credential |
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Telephone | 727-667-0436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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