Provider Demographics
NPI:1609187061
Name:A MUTUAL DESTINY, INC.
Entity Type:Organization
Organization Name:A MUTUAL DESTINY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEWEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-289-9740
Mailing Address - Street 1:6501 VETERANS PKWY
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-3169
Mailing Address - Country:US
Mailing Address - Phone:706-289-9740
Mailing Address - Fax:706-660-9989
Practice Address - Street 1:6501 VETERANS PKWY
Practice Address - Street 2:SUITE 1-C
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3169
Practice Address - Country:US
Practice Address - Phone:706-289-9740
Practice Address - Fax:706-660-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA09072060343900000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle