Organization
MED-360
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEISHA LYNNETTA JOHNSON (CEO)
(678) 675-5858
Entity
Organization
Contact information
Practice address
318 JEFFERSON DR, ATLANTA, GA 30350-7107
(678) 675-5858
Mailing address
7527 ROSWELL RD STE 566601, ATLANTA, GA 30350-4838
(678) 675-5858
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
18-56351
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20256750065
GEORGIA REVENUE
GA
Enumeration date
07/25/2018
Last updated
07/25/2018
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