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General NPI Number Information
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NPI Number | 1619768702
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Entity Type | Organization
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Legal Business Name | SOUTHWEST TRANSPORT LLC
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 1014 24TH ST
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City | MCCOMB
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State | MS
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Zip | 39648-5325
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Country | US
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Telephone | 404-573-9344
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Fax |
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Provider Business Mailing Address
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Address Line | 506 SHARPSTONE BND
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-9434
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Country | US
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Telephone | 404-573-9344
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CEDRIC CEBON CLARK
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Credential |
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Telephone | 404-573-9344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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