Provider Demographics
NPI:1164816336
Name:URGENT CARE MEDICAL TRANSPORT, CORP
Entity Type:Organization
Organization Name:URGENT CARE MEDICAL TRANSPORT, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-415-9427
Mailing Address - Street 1:2442 STONE MOUNTAIN LITHONIA RD STE E
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-5247
Mailing Address - Country:US
Mailing Address - Phone:904-415-9427
Mailing Address - Fax:
Practice Address - Street 1:2442 STONE MOUNTAIN LITHONIA RD
Practice Address - Street 2:STE E
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-5247
Practice Address - Country:US
Practice Address - Phone:904-415-9427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-353416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport