MEDICARE: VANGUARD RN TRANSPORTATION SERVICES

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	:	1952196180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANGUARD RN TRANSPORTATION SERVICES

Provider Business Mailing Address
First Line	:	214 POUNDS DR
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-1856
Country	:	US
Telephone Number	:	770-376-1150
Fax Number	:

Provider Business Practice Location Address
First Line	:	957 MAIN ST STE A
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-3060
Country	:	US
Telephone Number	:	770-285-1128
Fax Number	:	770-285-1128

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	NAELISHA JAMES
Credential	:	RN
Telephone Number	:	770-285-1128

Provider Enumeration Date	:	04/09/2025
Last Update Date	:	07/03/2025

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