Provider Demographics
NPI:1275020430
Name:ANN DOUGLAS TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:ANN DOUGLAS TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COPORATE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:DOUGALS
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-371-9302
Mailing Address - Street 1:376 TAPLEY RD
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-7330
Mailing Address - Country:US
Mailing Address - Phone:678-371-9302
Mailing Address - Fax:
Practice Address - Street 1:376 TAPLEY RD
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-7330
Practice Address - Country:US
Practice Address - Phone:678-371-9302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2018-000528343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)