=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669748471
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRECIOUS CARGO TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2012
-----------------------------------------------------
Last Update Date | 03/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4506 YATES RD
-----------------------------------------------------
City | COLLEGE PARK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30337-5212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-925-4706
-----------------------------------------------------
Fax | 404-478-8489
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1327
-----------------------------------------------------
City | RED OAK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30272-1327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-925-4706
-----------------------------------------------------
Fax | 404-478-8489
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. VANESSA OLIVER WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-925-4706
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347E00000X
-----------------------------------------------------
Taxonomy Name | Transportation Broker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------