Provider Demographics
NPI:1508292293
Name:PRIORITY HEALTHCARE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:PRIORITY HEALTHCARE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAREDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-768-0201
Mailing Address - Street 1:115 PERIMETER CENTER PLACE
Mailing Address - Street 2:630
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346
Mailing Address - Country:US
Mailing Address - Phone:678-768-0201
Mailing Address - Fax:
Practice Address - Street 1:115 PERIMETER CENTER PL NE
Practice Address - Street 2:630
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-1249
Practice Address - Country:US
Practice Address - Phone:678-768-0201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051349337343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)