Provider Demographics
NPI:1205107059
Name:SIGNATURE TRANSPORT
Entity type:Organization
Organization Name:SIGNATURE TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-548-8785
Mailing Address - Street 1:4232 DEFOORS FARM TRL
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4067
Mailing Address - Country:US
Mailing Address - Phone:678-548-8785
Mailing Address - Fax:770-319-1019
Practice Address - Street 1:4232 DEFOORS FARM TRL
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-4067
Practice Address - Country:US
Practice Address - Phone:678-548-8785
Practice Address - Fax:770-319-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)