Provider Demographics
NPI:1790475317
Name:TDB COMMUNITY TRANSPORT
Entity Type:Organization
Organization Name:TDB COMMUNITY TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZE OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:NEMT
Authorized Official - Phone:404-210-8681
Mailing Address - Street 1:2012 LANTERN DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-6995
Mailing Address - Country:US
Mailing Address - Phone:404-210-8681
Mailing Address - Fax:
Practice Address - Street 1:2012 LANTERN DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-6995
Practice Address - Country:US
Practice Address - Phone:404-210-8681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)