MEDICARE: GEORGIA TRANS CARE SVCS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1134453426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA TRANS CARE SVCS, LLC

Provider Business Mailing Address
First Line	:	3166 CHESTNUT DRIVE CONN
Second Line	:	SUITE 102
City	:	ATLANTA
State	:	GA
Zip	:	30340-3242
Country	:	US
Telephone Number	:	404-424-4918
Fax Number	:	770-783-8522

Provider Business Practice Location Address
First Line	:	3166 CHESTNUT DRIVE CONN
Second Line	:	SUITE 102
City	:	ATLANTA
State	:	GA
Zip	:	30340-3242
Country	:	US
Telephone Number	:	404-424-4918
Fax Number	:	770-783-8522

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MOISES XAVIER MORALES
Credential	:	M.B.A.
Telephone Number	:	770-330-5300

Provider Enumeration Date	:	09/20/2009
Last Update Date	:	09/20/2009

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