=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780569848
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARTER V.I.N.E. TRANSPORT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2025
-----------------------------------------------------
Last Update Date | 08/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3869 BROOKFIELD DR
-----------------------------------------------------
City | VALDOSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31605-4807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-273-4215
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3869 BROOKFIELD DR
-----------------------------------------------------
City | VALDOSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31605-4807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-273-4215
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | CEDRIC CARTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-273-4215
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------