MEDICARE: LIMBCARE PROSTHETICS & ORTHOTICS OF GEORGIA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	21	GA

General Provider Information

NPI Number	:	1427456334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIMBCARE PROSTHETICS & ORTHOTICS OF GEORGIA INC

Provider Business Mailing Address
First Line	:	2320 HAMILTON RD
Second Line	:	STE B
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8534
Country	:	US
Telephone Number	:	706-576-3779
Fax Number	:	706-576-6858

Provider Business Practice Location Address
First Line	:	2320 HAMILTON RD
Second Line	:	STE B
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8534
Country	:	US
Telephone Number	:	706-576-3779
Fax Number	:	706-576-6858

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MR. JOHN P RODMAN SR.
Credential	:	CPO
Telephone Number	:	229-430-9778

Provider Enumeration Date	:	12/09/2014
Last Update Date	:	12/09/2014

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