Healthcare Provider Details

I. General information

NPI: 1942506761
Provider Name (Legal Business Name): ATLANTA PROSTHETICS & ORTHOTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SHERWOOD PARK DRIVE SUITE 220
GAINESVILLE GA
30501
US

IV. Provider business mailing address

PO BOX 650846
DALLAS TX
75265-0846
US

V. Phone/Fax

Practice location:
  • Phone: 770-287-2395
  • Fax: 770-287-2398
Mailing address:
  • Phone: 404-618-0451
  • Fax: 404-636-8884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number000008
License Number StateGA

VIII. Authorized Official

Name: SHERYL PRICE
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 503-493-8288