Provider Demographics
NPI:1477839538
Name:SHEPHERD'S MEDICAL TRANSPORTATION SERVICES,LLC
Entity Type:Organization
Organization Name:SHEPHERD'S MEDICAL TRANSPORTATION SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZENDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-835-7690
Mailing Address - Street 1:PO BOX 1142
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-1142
Mailing Address - Country:US
Mailing Address - Phone:404-835-7690
Mailing Address - Fax:
Practice Address - Street 1:4641 ASH TREE ST
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-3359
Practice Address - Country:US
Practice Address - Phone:404-835-7690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)