Organization · NPI-2
Grace Care Ambulance Transport, LLC
Ambulance, Land Transport · Lithonia, GA
NPI number1003321662
StatusActive
Last updated in NPPESMay 28, 2025
Details
- NPI
- 1003321662
- Entity type
- Organization (NPI-2)
- Legal business name
- Grace Care Ambulance Transport, LLC
- Organization subpart
- No
- Enumeration date
- Dec 5, 2017
- Certification date
- May 13, 2025
- Last updated
- May 28, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3416L0300X | Ambulance, Land Transport | – | – | Yes |
Practice location
2372 S Stone Mountain Rd.Ste D
Lithonia, GA 30058
Phone 404-585-4857 · Fax 404-521-4686
Mailing address
2372 S Stone Mountain RdSuite D
Lithonia, GA 30058
Phone 404-585-4857 · Fax 404-393-4041
Authorized official
Carlton Theodore Anthony
Owner
4045854857
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