Provider Demographics
NPI:1609646371
Name:SUPREME MOTOR SPORTZ LLC
Entity Type:Organization
Organization Name:SUPREME MOTOR SPORTZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUPREME
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-884-7343
Mailing Address - Street 1:2897 N DRUID HILLS RD NE STE 351
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3924
Mailing Address - Country:US
Mailing Address - Phone:470-884-7343
Mailing Address - Fax:
Practice Address - Street 1:1830 AIRPORT INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9217
Practice Address - Country:US
Practice Address - Phone:800-750-5316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company