Grace Medical Transport LLC

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

Legal business name

GRACE MEDICAL TRANSPORT LLC

Practice address

117 3Rd St E
Tifton, GA 31794-4879

Phone

(229) 396-5791

Fax

(229) 396-4046

NPI assigned

May 29, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Wendy G Jackson, N/A

Title

Principal

Phone

(229) 396-5791

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685318400000",
    "number": "1255024113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 3RD ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317944879",
            "telephone_number": "229-396-5791",
            "fax_number": "229-396-4046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 3RD ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317944879",
            "telephone_number": "229-396-5791",
            "fax_number": "229-396-4046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE MEDICAL TRANSPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-29",
        "last_updated": "2023-05-29",
        "certification_date": "2023-05-27",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "229-396-5791",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "N/A"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenslee Goodman
• Patrick Glenn Goodman, MD
• Landis Coffee Gordon, PA-C
• Susan Riddle Gordon, LCSW
• Gowdy Enterprises
• Deraine H Graham, NP
• James L Graham Jr., MD
• Ravi Kiran Grandhi, MD
• Christopher Gravitt, FNP-C
• Audrey Green-Campbell

• Non-emergency Medical Transport (VAN) in Tifton, GA
• Providers in Tifton, GA by specialty
• Non-emergency Medical Transport (VAN) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.