Supreme Medical Transportation LLC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

SUPREME MEDICAL TRANSPORTATION LLC

Practice address

5241 W Fayetteville Rd Ste a
Atlanta, GA 30349-5413

Phone

(404) 337-2731

NPI assigned

Nov 29, 2017

Organization subpart

No

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

Authorized official

Name

Dyshann Mack

Title

Owner

Phone

(404) 337-2731

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1511913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524441600000",
    "number": "1427562479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "836 4TH AVE",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257011407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5241 W FAYETTEVILLE RD STE A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303495413",
            "telephone_number": "404-337-2731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME MEDICAL TRANSPORTATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-29",
        "last_updated": "2018-04-23",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "DYSHANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-337-2731"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "GA",
            "license": "AMB2018013",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Land Ambulance in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Land Ambulance in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2018; 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.