Provider Demographics
NPI:1255165114
Name:GILLIAM TWINS TRANSPORTATION LLC
Entity type:Organization
Organization Name:GILLIAM TWINS TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-465-2259
Mailing Address - Street 1:624 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8002
Mailing Address - Country:US
Mailing Address - Phone:682-465-2259
Mailing Address - Fax:
Practice Address - Street 1:624 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8002
Practice Address - Country:US
Practice Address - Phone:682-465-2259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)