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General NPI Number Information
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NPI Number | 1639545379
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Entity Type | Organization
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Legal Business Name | NA TRANSPORT SOUTH
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 111 BIENCOURT DR
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City | GRIFFIN
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State | GA
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Zip | 30223-8733
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Country | US
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Telephone | 678-588-4380
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Fax |
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Provider Business Mailing Address
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Address Line | 111 BIENCOURT DR
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City | GRIFFIN
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State | GA
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Zip | 30223-8733
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Country | US
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Telephone | 678-588-4380
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. NIEKA TALLEY
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Credential |
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Telephone | 678-588-4380
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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 | 055391639
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License Number State | GA
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