=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760974521
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAWK ONE TRANSPORTATION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2018
-----------------------------------------------------
Last Update Date | 06/06/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 412 MCKINLEY ST
-----------------------------------------------------
City | THOMASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-200-9781
-----------------------------------------------------
Fax | 229-226-8932
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2974
-----------------------------------------------------
City | THOMASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31799-2974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-200-9781
-----------------------------------------------------
Fax | 229-226-8932
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MISS LOVETTA JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 229-200-9781
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347E00000X
-----------------------------------------------------
Taxonomy Name | Transportation Broker
-----------------------------------------------------
License Number | 056033077
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------