Provider Demographics
NPI:1912471699
Name:SOUTHERN CARE MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:SOUTHERN CARE MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EZRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-934-3322
Mailing Address - Street 1:519 FOREST PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-6113
Mailing Address - Country:US
Mailing Address - Phone:404-934-3322
Mailing Address - Fax:678-732-9238
Practice Address - Street 1:519 FOREST PKWY STE 240
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-6113
Practice Address - Country:US
Practice Address - Phone:404-934-3322
Practice Address - Fax:678-732-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport