Provider Demographics
NPI:1366226102
Name:TMD DIVERSE TRANSPORT LLC
Entity type:Organization
Organization Name:TMD DIVERSE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMALA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-886-7141
Mailing Address - Street 1:129 SAVANNAH CT
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-6451
Mailing Address - Country:US
Mailing Address - Phone:229-886-7141
Mailing Address - Fax:
Practice Address - Street 1:129 SAVANNAH CT
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-6451
Practice Address - Country:US
Practice Address - Phone:229-886-7141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle