Organization
MADISON GRACE TRANSPORT LLC
Active
Other names
Madison Grace Transport
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAWRENCE LEE SULLIVAN (OWNER)
(601) 618-0175
Entity
Organization
Contact information
Practice address
126 LE FLEURS DR, VICKSBURG, MS 39180-8850
(801) 618-0175
Mailing address
126 LE FLEURS DR, VICKSBURG, MS 39180-8850
(801) 618-0175
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
08/29/2025
Last updated
08/29/2025
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