Provider Demographics
NPI:1043560584
Name:SELECT CHOICE LLC
Entity Type:Organization
Organization Name:SELECT CHOICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMETRICH
Authorized Official - Middle Name:ANTWONE
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-431-6812
Mailing Address - Street 1:2426 PARK CENTRAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-3901
Mailing Address - Country:US
Mailing Address - Phone:678-431-6812
Mailing Address - Fax:866-371-3489
Practice Address - Street 1:2426 PARK CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-3901
Practice Address - Country:US
Practice Address - Phone:678-431-6812
Practice Address - Fax:866-371-3489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA603416L0300X
GA044-333416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport