Healthcare Provider Details

I. General information

NPI: 1336542224
Provider Name (Legal Business Name): FOURROUX PROSTHETICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6630 MCGINNIS FERRY RD STE A
DULUTH GA
30097-1563
US

IV. Provider business mailing address

2743 BOB WALLACE AVE SW
HUNTSVILLE AL
35805-4103
US

V. Phone/Fax

Practice location:
  • Phone: 678-584-1706
  • Fax: 800-963-5010
Mailing address:
  • Phone: 256-534-8672
  • Fax: 800-963-5010

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. W KEITH WATSON
Title or Position: OWNER / PRESIDENT
Credential: CPO
Phone: 256-534-8672