Provider Demographics
NPI:1578951877
Name:VAN DORN'S MEDICAL TRANSPORT, LLC
Entity Type:Organization
Organization Name:VAN DORN'S MEDICAL TRANSPORT, LLC
Other - Org Name:VANDORN'S MEDICAL TRANSPORT, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:T
Authorized Official - Last Name:VAN DORN
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP-C
Authorized Official - Phone:404-826-3676
Mailing Address - Street 1:2007 PINE FOREST CT
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-5417
Mailing Address - Country:US
Mailing Address - Phone:404-826-3676
Mailing Address - Fax:
Practice Address - Street 1:2007 PINE FOREST CT
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-5417
Practice Address - Country:US
Practice Address - Phone:404-826-3676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)