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General NPI Number Information
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NPI Number | 1467709162
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Entity Type | Organization
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Legal Business Name | SOUTH STAR TRANSPORT, INC
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 3675 CRESTWOOD PKWY NW
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City | DULUTH
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State | GA
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Zip | 30096-1805
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Country | US
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Telephone | 404-322-7089
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Fax | 866-717-2986
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Provider Business Mailing Address
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Address Line | PO BOX 135
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City | LILBURN
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State | GA
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Zip | 30048-0135
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Country | US
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Telephone | 404-322-7089
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Fax | 866-717-2986
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Authorized Official
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Title or Position | OWNER
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Name | MS. DANA FAYONNE OWENS
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Credential |
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Telephone | 404-322-7089
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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 | 600165
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License Number State | GA
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