Provider Demographics
NPI:1629355714
Name:JET3-TRANS, LLC
Entity Type:Organization
Organization Name:JET3-TRANS, LLC
Other - Org Name:JET3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRIMICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-587-9225
Mailing Address - Street 1:165 LOST COVE DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-7535
Mailing Address - Country:US
Mailing Address - Phone:205-587-9225
Mailing Address - Fax:
Practice Address - Street 1:3201 ATLANTA INDUSTRIAL PKWY NW
Practice Address - Street 2:204
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-1045
Practice Address - Country:US
Practice Address - Phone:678-744-5383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1501017292343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)