Healthcare Provider Details

I. General information

NPI: 1891796785
Provider Name (Legal Business Name): PROSTHETIC CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 COMMERCE DR
BUFORD GA
30518-3489
US

IV. Provider business mailing address

4460 COMMERCE DR
BUFORD GA
30518-3489
US

V. Phone/Fax

Practice location:
  • Phone: 770-271-5581
  • Fax: 770-271-5531
Mailing address:
  • Phone: 770-271-5581
  • Fax: 770-271-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PALLAVI CHINTAPALLI NEMANI
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 512-552-6311