Healthcare Provider Details

I. General information

NPI: 1952395261
Provider Name (Legal Business Name): INNOVATIVE ORTHOTICS & REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 DEKALB AVE NE
ATLANTA GA
30307-2027
US

IV. Provider business mailing address

1300 DEKALB AVE NE
ATLANTA GA
30307-2027
US

V. Phone/Fax

Practice location:
  • Phone: 404-222-9998
  • Fax: 404-222-9958
Mailing address:
  • Phone: 404-222-9998
  • Fax: 404-222-9958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateGA

VIII. Authorized Official

Name: MRS. ANGELIA S DEFRANCIS
Title or Position: PARTNER
Credential: PARTNER
Phone: 404-222-9998