Provider Demographics
NPI:1669234357
Name:EMPIRE MARATHON LOGISTICS
Entity type:Organization
Organization Name:EMPIRE MARATHON LOGISTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:BRAZIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-488-7057
Mailing Address - Street 1:1077 BLACKSHEAR FERRY RD W
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3252
Mailing Address - Country:US
Mailing Address - Phone:478-488-7057
Mailing Address - Fax:
Practice Address - Street 1:1077 BLACKSHEAR FERRY RD W
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3252
Practice Address - Country:US
Practice Address - Phone:478-488-7057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)