Provider Demographics
NPI:1336815588
Name:ATL ALLY-MED TRANSPORT LOGISTICS, LLC.
Entity Type:Organization
Organization Name:ATL ALLY-MED TRANSPORT LOGISTICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:T
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:404-444-3040
Mailing Address - Street 1:1343 BAILEYS COR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2072
Mailing Address - Country:US
Mailing Address - Phone:404-444-3040
Mailing Address - Fax:
Practice Address - Street 1:1343 BAILEYS COR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-2072
Practice Address - Country:US
Practice Address - Phone:404-444-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance