Provider Demographics
NPI:1114767746
Name:PG ELITE TRANSPORTATION
Entity type:Organization
Organization Name:PG ELITE TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RENIESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-951-9450
Mailing Address - Street 1:2400 HERODIAN WAY SE STE 220
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8500
Mailing Address - Country:US
Mailing Address - Phone:678-467-8671
Mailing Address - Fax:678-666-1988
Practice Address - Street 1:2400 HERODIAN WAY SE STE 220
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8500
Practice Address - Country:US
Practice Address - Phone:678-467-8671
Practice Address - Fax:678-666-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)