=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801612817
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A & B TRANSPORTATION LLC09
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2024
-----------------------------------------------------
Last Update Date | 11/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2487 CEDARCREST RD STE 222
-----------------------------------------------------
City | ACWORTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30101-2729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-993-8245
-----------------------------------------------------
Fax | 888-993-8245
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 801403
-----------------------------------------------------
City | ACWORTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30101-1217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-993-8245
-----------------------------------------------------
Fax | 888-993-8245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MISS AMANDA BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 470-953-7381
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------