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General NPI Number Information
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NPI Number | 1902207186
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Entity Type | Organization
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Legal Business Name | STAR TREATMENT TRANSPORTATION LLC
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 165 COMMERCE DR STE B
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1376
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Country | US
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Telephone | 770-719-2500
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Fax | 770-719-2555
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Provider Business Mailing Address
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Address Line | 165 COMMERCE DR STE B
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1376
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Country | US
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Telephone | 770-719-2500
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Fax | 770-719-2555
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. MELVIN MORRIS
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Credential |
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Telephone | 404-914-0655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State | GA
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