=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366790180
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERRANDS ON US LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2012
-----------------------------------------------------
Last Update Date | 08/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6471 CASTLE CT WAY
-----------------------------------------------------
City | LITHONIA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30058-3139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-484-4328
-----------------------------------------------------
Fax | 770-322-8185
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6471 CASTLE COURT WAY
-----------------------------------------------------
City | LITHONIA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30058-3139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-484-4328
-----------------------------------------------------
Fax | 770-322-8185
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/REGISTERED AGENT
-----------------------------------------------------
Name | MRS. STEPHANIE HUTCHINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 678-779-0393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number | 054907031
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------