Provider Demographics
NPI:1306118708
Name:THOMASVILLE BROKERAGE
Entity type:Organization
Organization Name:THOMASVILLE BROKERAGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ATLEMISIA
Authorized Official - Middle Name:MA'KARA
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-379-1007
Mailing Address - Street 1:1304 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4749
Mailing Address - Country:US
Mailing Address - Phone:229-379-1007
Mailing Address - Fax:229-236-0134
Practice Address - Street 1:1304 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4749
Practice Address - Country:US
Practice Address - Phone:229-379-1007
Practice Address - Fax:229-236-0134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA343800000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)