Provider Demographics
NPI:1790064053
Name:T.L.C.TRANSPORTATION.ORG
Entity Type:Organization
Organization Name:T.L.C.TRANSPORTATION.ORG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:678-620-9580
Mailing Address - Street 1:1201 PEACHTREE ST
Mailing Address - Street 2:400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30361-3503
Mailing Address - Country:US
Mailing Address - Phone:678-620-9580
Mailing Address - Fax:
Practice Address - Street 1:1201 PEACHTREE ST
Practice Address - Street 2:400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30361-3503
Practice Address - Country:US
Practice Address - Phone:678-620-9580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)