Provider Demographics
NPI:1073273231
Name:WARE, ALFRED ANTONIO (NEMT)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:ANTONIO
Last Name:WARE
Suffix:
Gender:M
Credentials:NEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 REVERE CT
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-1725
Mailing Address - Country:US
Mailing Address - Phone:706-416-2888
Mailing Address - Fax:
Practice Address - Street 1:107 REVERE CT
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-1725
Practice Address - Country:US
Practice Address - Phone:706-416-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055043348172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver