=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770262495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRUMS A-1 TRANSPORT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2023
-----------------------------------------------------
Last Update Date | 07/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8413 CHICAGO AVE, SUITE B
-----------------------------------------------------
City | DOUGLASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30134-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-363-5324
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4625 SMOKESTONE DR
-----------------------------------------------------
City | DOUGLASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30135-4991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-310-5475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | MRS. CASSANDRA M CRUM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-310-5475
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------