Provider Demographics
NPI:1407477680
Name:CDG TRANSPO
Entity type:Organization
Organization Name:CDG TRANSPO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORITA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-461-6046
Mailing Address - Street 1:1074 SUN VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-7593
Mailing Address - Country:US
Mailing Address - Phone:478-461-6046
Mailing Address - Fax:
Practice Address - Street 1:1074 SUN VALLEY CT
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-7593
Practice Address - Country:US
Practice Address - Phone:478-461-6046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty