# TRANSPORT AMERICA AMBULANCE SERVICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033469598
- **Authorized official:** MRS. LISA DARLENE FLANAGAN DO (CFO)
- **Authorized official phone:** (912) 805-2006

## Contact information

- **Practice address:** 603 BROGDON ST, VIDALIA, GA 30474-6031
- **Practice address phone:** (902) 805-2007
- **Practice address fax:** (912) 805-2004
- **Mailing address:** PO BOX 1872, VIDALIA, GA 30475-1872
- **Mailing address phone:** (912) 805-2006
- **Mailing address fax:** (912) 805-2004

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 076-02 | GA | Yes |

## Other

- **Enumeration date:** 09/12/2012
- **Last updated:** 06/24/2021