Healthcare Provider Details

I. General information

NPI: 1669403291
Provider Name (Legal Business Name): BRUNSWICK ORTHOTICS & PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 ALTAMA AVE
BRUNSWICK GA
31520-3629
US

IV. Provider business mailing address

3501 ALTAMA AVE
BRUNSWICK GA
31520-3629
US

V. Phone/Fax

Practice location:
  • Phone: 912-261-8117
  • Fax: 912-261-8301
Mailing address:
  • Phone: 912-261-8117
  • Fax: 912-261-8301

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: MR. DAVID SHANNON THOMPSON
Title or Position: C.P.O.
Credential: C.P.O.
Phone: 912-261-8117