Healthcare Provider Details

I. General information

NPI: 1275875395
Provider Name (Legal Business Name): CHOA ORTHOTICS AND PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 EXECUTIVE PARK DR NE
ATLANTA GA
30329-2221
US

IV. Provider business mailing address

1575 NORTHEAST EXPY NE
BROOKHAVEN GA
30329-2401
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-2570
  • Fax: 404-785-2565
Mailing address:
  • Phone: 404-785-7876
  • Fax: 404-785-7932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: LOUETTA CODY
Title or Position: MANAGER, PROVIDER ENROLLMENT
Credential:
Phone: 404-785-7876