Provider Demographics
NPI:1952800062
Name:POLITE, ERVIN
Entity Type:Individual
Prefix:
First Name:ERVIN
Middle Name:
Last Name:POLITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 EMERALD SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7225
Mailing Address - Country:US
Mailing Address - Phone:770-369-1699
Mailing Address - Fax:
Practice Address - Street 1:2760 EMERALD SPRINGS DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7225
Practice Address - Country:US
Practice Address - Phone:770-369-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-04
Last Update Date:2018-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035434968343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)