MEDICARE: SOUTHERN COAST TRANSIT

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	:	1861174732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN COAST TRANSIT

Provider Business Mailing Address
First Line	:	11720 AMBER PARK DR STE 160 PMB 1162
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11720 AMBER PARK DR STE 160
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-2271
Country	:	US
Telephone Number	:	470-664-2700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN EVERETTE
Credential	:
Telephone Number	:	912-322-4502

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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Directions to “SOUTHERN COAST TRANSIT ” Practice Location

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