MEDICARE: GUARDIAN MEDICAL TRANSPORT

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	:	1548541691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN MEDICAL TRANSPORT

Provider Business Mailing Address
First Line	:	4307 GREEN HILL RD
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30506-3574
Country	:	US
Telephone Number	:	678-943-6015
Fax Number	:	770-531-7664

Provider Business Practice Location Address
First Line	:	4307 GREEN HILL RD
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30506-3574
Country	:	US
Telephone Number	:	678-943-6015
Fax Number	:	770-531-7664

Authorized Official
Title or Position	:	OWNER
Name	:	DUSTIN M SMITH
Credential	:
Telephone Number	:	678-943-6015

Provider Enumeration Date	:	09/02/2011
Last Update Date	:	09/02/2011

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