Provider Demographics
NPI:1376971192
Name:ROYAL MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:ROYAL MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:678-571-1952
Mailing Address - Street 1:2145 LOST FOREST LN SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6118
Mailing Address - Country:US
Mailing Address - Phone:678-571-1952
Mailing Address - Fax:
Practice Address - Street 1:2145 LOST FOREST LN SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6118
Practice Address - Country:US
Practice Address - Phone:678-571-1952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)