Healthcare Provider Details

I. General information

NPI: 1023345220
Provider Name (Legal Business Name): LIMBCARE PROSTHETICS & ORTHOTICS OF GEORGIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 GREER ST UNIT A
CORDELE GA
31015-2090
US

IV. Provider business mailing address

915 GREER ST UNIT A
CORDELE GA
31015-2090
US

V. Phone/Fax

Practice location:
  • Phone: 229-430-9778
  • Fax: 229-430-1347
Mailing address:
  • Phone: 229-430-9778
  • Fax: 229-430-1347

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: MR. JOHN PATRICK RODMAN SR.
Title or Position: OWNER/CEO
Credential: CPO
Phone: 229-430-9778