=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639871957
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLM TRANSPORTATION LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2023
-----------------------------------------------------
Last Update Date | 03/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1309 HARTLEY AVE
-----------------------------------------------------
City | WARNER ROBINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31088-4508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-250-6340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1309 HARTLEY AVE
-----------------------------------------------------
City | WARNER ROBINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31088-4508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-250-6340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | JESSICA IVORY MACK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 478-250-6340
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 342000000X
-----------------------------------------------------
Taxonomy Name | Transportation Network Company
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------