Provider Demographics
NPI:1689334831
Name:DANNIE MAE'S EXPRESS
Entity Type:Organization
Organization Name:DANNIE MAE'S EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-530-6515
Mailing Address - Street 1:85 MOUNT ZION RD SW APT 85
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30354-2335
Mailing Address - Country:US
Mailing Address - Phone:470-530-6515
Mailing Address - Fax:
Practice Address - Street 1:1990 RAMBLING DR SW UNIT 106
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-5954
Practice Address - Country:US
Practice Address - Phone:470-530-6515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)