Provider Demographics
NPI:1285109140
Name:ATLANTA LUXURY COACH
Entity type:Organization
Organization Name:ATLANTA LUXURY COACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS-LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-627-6369
Mailing Address - Street 1:1100 PEACHTREE ST NE STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4503
Mailing Address - Country:US
Mailing Address - Phone:404-795-6038
Mailing Address - Fax:
Practice Address - Street 1:1100 PEACHTREE ST NE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-4503
Practice Address - Country:US
Practice Address - Phone:404-795-6038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)