Provider Demographics
NPI:1598474280
Name:ONE GIRL GANG LLC
Entity Type:Organization
Organization Name:ONE GIRL GANG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHUNTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-488-6962
Mailing Address - Street 1:3708 CARL WHITE PL
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37410-1267
Mailing Address - Country:US
Mailing Address - Phone:423-488-6962
Mailing Address - Fax:
Practice Address - Street 1:5751 UPTAIN RD STE 300
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5673
Practice Address - Country:US
Practice Address - Phone:423-893-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle