=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497406078
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D & O GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2022
-----------------------------------------------------
Last Update Date | 01/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 214 W GAY ST
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37087-3519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-957-1816
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4193 BEECH LOG RD
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37090-0724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-957-1816
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. RANDY D ARCHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-957-1816
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347E00000X
-----------------------------------------------------
Taxonomy Name | Transportation Broker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------