Healthcare Provider Details

I. General information

NPI: 1255642542
Provider Name (Legal Business Name): HUTTO LIMB AND BRACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1538 13TH AVE BUILDING B-200
COLUMBUS GA
31901-1956
US

IV. Provider business mailing address

1538 13TH AVE BUILDING B-200
COLUMBUS GA
31901-1956
US

V. Phone/Fax

Practice location:
  • Phone: 706-507-4254
  • Fax: 706-507-4256
Mailing address:
  • Phone: 706-507-4254
  • Fax: 706-507-4256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberGA0000018
License Number StateGA

VIII. Authorized Official

Name: MR. EDWARD LAMAR HUTTO SR.
Title or Position: PRESIDENT
Credential: CPO/LPO
Phone: 706-507-4254