Provider Demographics
NPI:1497177281
Name:PRESTIGE HEALTHCARE SOUTH LLC
Entity Type:Organization
Organization Name:PRESTIGE HEALTHCARE SOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-768-5614
Mailing Address - Street 1:PO BOX 1171
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:GA
Mailing Address - Zip Code:30272-1171
Mailing Address - Country:US
Mailing Address - Phone:678-768-5614
Mailing Address - Fax:404-506-9074
Practice Address - Street 1:5639 DEERFIELD CT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-3768
Practice Address - Country:US
Practice Address - Phone:678-768-5614
Practice Address - Fax:404-506-9074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X, 3416A0800X, 3416L0300X, 343800000X, 343900000X, 344600000X, 347B00000X, 347C00000X, 347E00000X
GA13404905347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No341600000XTransportation ServicesAmbulance
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No347B00000XTransportation ServicesBus
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker