Provider Demographics
NPI:1609329143
Name:GEORGIA T4 TRANSPORTATION ENTERPRISE, LLC
Entity Type:Organization
Organization Name:GEORGIA T4 TRANSPORTATION ENTERPRISE, LLC
Other - Org Name:GA T4 NET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-855-7532
Mailing Address - Street 1:614 SUMMER XING
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2126
Mailing Address - Country:US
Mailing Address - Phone:404-855-7532
Mailing Address - Fax:888-345-4578
Practice Address - Street 1:614 SUMMER XING
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-2126
Practice Address - Country:US
Practice Address - Phone:404-855-7532
Practice Address - Fax:888-345-4578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)