Provider Demographics
NPI:1205328630
Name:ATLANTA WELLNESS TRANSPORTATION
Entity type:Organization
Organization Name:ATLANTA WELLNESS TRANSPORTATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-271-0475
Mailing Address - Street 1:541 HOLDERNESS ST SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1750
Mailing Address - Country:US
Mailing Address - Phone:404-271-0475
Mailing Address - Fax:404-752-8992
Practice Address - Street 1:541 HOLDERNESS ST SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1750
Practice Address - Country:US
Practice Address - Phone:404-271-0475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker