=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972447530
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDLIFE MEDICAL TRANSPORT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2026
-----------------------------------------------------
Last Update Date | 04/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3165 DOGWOOD DR UNIT 102
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30354-1195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-901-2040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3165 DOGWOOD DR UNIT 102
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30354-1195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MIKAL GRAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-901-2040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------