Provider Demographics
NPI:1538805940
Name:ESSENTIAL TRANSPORT PROVIDERS LLC
Entity type:Organization
Organization Name:ESSENTIAL TRANSPORT PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-504-5529
Mailing Address - Street 1:PO BOX 490091
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-0010
Mailing Address - Country:US
Mailing Address - Phone:770-925-5339
Mailing Address - Fax:866-798-8989
Practice Address - Street 1:2245 GODBY RD STE 130
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5059
Practice Address - Country:US
Practice Address - Phone:779-925-5339
Practice Address - Fax:866-798-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003299820AMedicaid