Organization
DIVINE DESTINY ENTERPRISE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELATHUM MOORE (MEMBER)
(678) 394-6573
Entity
Organization
Contact information
Practice address
670 BIRKDALE DR, FAIRBURN, GA 30213-2924
(678) 394-6573
Mailing address
225 MARKET PLACE CONNECTOR # 1144, PEACHTREE CITY, GA 30269-3542
(678) 929-1123
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
03/08/2023
Last updated
03/08/2023
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