Provider Demographics
NPI:1902125552
Name:HUMPHRIES TRANSPORTATION COMPANY LLC
Entity Type:Organization
Organization Name:HUMPHRIES TRANSPORTATION COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:678-314-4045
Mailing Address - Street 1:PO BOX 671363
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-0140
Mailing Address - Country:US
Mailing Address - Phone:678-314-4045
Mailing Address - Fax:
Practice Address - Street 1:3244 CHESTNUT OAKS DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6614
Practice Address - Country:US
Practice Address - Phone:678-314-4045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2010#137102343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)