MEDICARE: E MEDICAL TRANSPORTATION SERVICES 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)		GA
2	347E00000X	Transportation Broker		GA

General Provider Information

NPI Number	:	1568849032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E MEDICAL TRANSPORTATION SERVICES LLC

Provider Business Mailing Address
First Line	:	500 LANIER AVE W STE 908
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-7641
Country	:	US
Telephone Number	:	678-571-7318
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 LANIER AVE W STE 908
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-7641
Country	:	US
Telephone Number	:	678-571-7318
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRACY PEARSON
Credential	:
Telephone Number	:	678-571-7318

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	05/04/2015

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