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General NPI Number Information
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NPI Number | 1770428336
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Entity Type | Organization
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Legal Business Name | MEDCORE TRANSPORTATION LLC
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Dates
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Enumeration Date | 04/21/2026
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Last Update Date | 04/21/2026
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Provider Practice Location Address
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Address Line | 125 RIDGEWOOD DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-8153
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Country | US
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Telephone | 404-644-9983
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Fax |
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Provider Business Mailing Address
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Address Line | 506 N JEFF DAVIS DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1632
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Country | US
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Telephone | 404-644-9983
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMARA JACKSON
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Credential |
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Telephone | 404-483-4337
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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 |
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License Number State |
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