Provider Demographics
NPI:1194505628
Name:DELTAMED MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:DELTAMED MEDICAL TRANSPORT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAWKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-779-7799
Mailing Address - Street 1:1954 AIRPORT RD STE 131
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4956
Mailing Address - Country:US
Mailing Address - Phone:404-779-7799
Mailing Address - Fax:800-431-8656
Practice Address - Street 1:1954 AIRPORT RD STE 131
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-4956
Practice Address - Country:US
Practice Address - Phone:404-779-7799
Practice Address - Fax:800-431-8656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport