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General NPI Number Information
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NPI Number | 1942333794
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Entity Type | Organization
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Legal Business Name | MANAGED MEDICAL TRANSPORT, INC.
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1080 COMMERCE DR SUITE 2
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City | BOGART
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State | GA
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Zip | 30622-3138
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Country | US
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Telephone | 706-355-3001
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Fax | 770-725-7558
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Provider Business Mailing Address
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Address Line | PO BOX 49905
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City | ATHENS
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State | GA
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Zip | 30604-0905
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Country | US
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Telephone | 706-355-3001
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Fax | 770-725-7558
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Authorized Official
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Title or Position | CEO
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Name | MS. LORI S. BROOKS
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Credential |
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Telephone | 706-355-3001
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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 | 138698
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License Number State | GA
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