Healthcare Provider Details

I. General information

NPI: 1588492425
Provider Name (Legal Business Name): ALLIANCE PROSTHETICS AND ORTHOTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1864 AUBURN ROAD SUITE 102
DACULA GA
30019
US

IV. Provider business mailing address

1241 FRIENDSHIP RD STE 120
BRASELTON GA
30517-5609
US

V. Phone/Fax

Practice location:
  • Phone: 770-679-3090
  • Fax: 770-679-3142
Mailing address:
  • Phone: 770-679-3090
  • Fax: 770-679-3142

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: JASON R AUYER
Title or Position: CPO/OWNER
Credential:
Phone: 770-379-3090