Provider Demographics
NPI:1790494375
Name:AMETHYST MOBILE SERVICES LLC
Entity Type:Organization
Organization Name:AMETHYST MOBILE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:V
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-948-7682
Mailing Address - Street 1:120 NATALIE CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-3198
Mailing Address - Country:US
Mailing Address - Phone:470-948-7682
Mailing Address - Fax:470-444-1993
Practice Address - Street 1:120 NATALIE CT
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-3198
Practice Address - Country:US
Practice Address - Phone:470-948-7682
Practice Address - Fax:470-444-1993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)