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General NPI Number Information
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NPI Number | 1306074307
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Entity Type | Organization
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Legal Business Name | FALCON TRANSPORT GA, LLC
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 06/29/2009
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Provider Practice Location Address
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Address Line | 11925 LEXINGTON WOODS DR
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City | ALPHARETTA
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State | GA
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Zip | 30005-6755
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Country | US
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Telephone | 678-373-8960
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Fax |
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Provider Business Mailing Address
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Address Line | 11106 SUPERIOR LNDG
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City | BOWIE
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State | MD
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Zip | 20720-3491
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | SHAUNE BENONS
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Credential |
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Telephone | 678-373-8960
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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 | 500749
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License Number State | GA
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