Healthcare Provider Details

I. General information

NPI: 1356150973
Provider Name (Legal Business Name): SV ORTHOTIC& PROSTHETIC COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 JOHNSON FERRY RD STE BUILDING II, SUITE LL80
ATLANTA GA
30342-1709
US

IV. Provider business mailing address

5735 BEAVER RIDGE DR
CUMMING GA
30040-0206
US

V. Phone/Fax

Practice location:
  • Phone: 608-772-9021
  • Fax:
Mailing address:
  • Phone: 608-772-9021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: GIRI TALLURI
Title or Position: CEO
Credential:
Phone: 608-772-9021