Provider Demographics
NPI:1073906996
Name:SOUTHERN CUSTOMZ LLC
Entity Type:Organization
Organization Name:SOUTHERN CUSTOMZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-217-5857
Mailing Address - Street 1:390 ROBIN WAY
Mailing Address - Street 2:
Mailing Address - City:EAST DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31027-1694
Mailing Address - Country:US
Mailing Address - Phone:470-217-5857
Mailing Address - Fax:478-304-1254
Practice Address - Street 1:390 ROBIN WAY
Practice Address - Street 2:
Practice Address - City:EAST DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31027-1694
Practice Address - Country:US
Practice Address - Phone:470-217-5857
Practice Address - Fax:478-304-1254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle