Provider Demographics
NPI:1750138103
Name:LIKINE, MEOMBE (RT(R))
Entity type:Individual
Prefix:
First Name:MEOMBE
Middle Name:
Last Name:LIKINE
Suffix:
Gender:M
Credentials:RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 ASHBURY CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-1440
Mailing Address - Country:US
Mailing Address - Phone:470-738-9609
Mailing Address - Fax:
Practice Address - Street 1:247 ASHBURY CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-1440
Practice Address - Country:US
Practice Address - Phone:470-738-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA22900342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company