MEDICARE: ESSENTIAL TRANSPORT PROVIDERS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	343800000X	Secured Medical Transport (VAN)
3	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538805940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL TRANSPORT PROVIDERS LLC

Provider Business Mailing Address
First Line	:	2245 GODBY RD STE 130
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-5059
Country	:	US
Telephone Number	:	770-925-5339
Fax Number	:	866-798-8989

Provider Business Practice Location Address
First Line	:	2245 GODBY RD STE 130
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-5059
Country	:	US
Telephone Number	:	779-925-5339
Fax Number	:	866-798-8989

Authorized Official
Title or Position	:	CFO
Name	:	LARRY KELLY
Credential	:
Telephone Number	:	904-504-5529

Provider Enumeration Date	:	05/09/2022
Last Update Date	:	05/04/2026

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Directions to “ESSENTIAL TRANSPORT PROVIDERS LLC ” Practice Location

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