Provider Demographics
NPI:1922610476
Name:BLOODSTONE AND PEARL TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:BLOODSTONE AND PEARL TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:470-545-0860
Mailing Address - Street 1:7002 ANNIE WALK
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4675
Mailing Address - Country:US
Mailing Address - Phone:470-545-0860
Mailing Address - Fax:470-300-7778
Practice Address - Street 1:1315 MILSTEAD RD NE STE 101
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3824
Practice Address - Country:US
Practice Address - Phone:470-545-0860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No3416L0300XTransportation ServicesAmbulanceLand Transport
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003217560GMedicaid