Provider Demographics
NPI:1013219245
Name:REPRAH ENTERPRISES,LLC
Entity Type:Organization
Organization Name:REPRAH ENTERPRISES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-246-4544
Mailing Address - Street 1:927 GRANITE SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-5102
Mailing Address - Country:US
Mailing Address - Phone:404-246-4544
Mailing Address - Fax:678-949-9293
Practice Address - Street 1:927 GRANITE SPRINGS LN
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-5102
Practice Address - Country:US
Practice Address - Phone:404-246-4544
Practice Address - Fax:678-949-9293
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REPRAH ENTERPRISES,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044016701343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA044016701OtherDHR