Organization
SUPREME MEDICAL TRANSPORTATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DYSHANN MACK (OWNER)
(404) 337-2731
Entity
Organization
Contact information
Practice address
5241 W FAYETTEVILLE RD STE A, ATLANTA, GA 30349-5413
(404) 337-2731
Mailing address
836 4TH AVE, HUNTINGTON, WV 25701-1407
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
AMB2018013
GA
3416L0300X
Land Ambulance
Primary
—
—
Other
Enumeration date
11/29/2017
Last updated
04/23/2018
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