Healthcare Provider Details

I. General information

NPI: 1609811157
Provider Name (Legal Business Name): HUTTO LIMB AND BRACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 JENKINS ST
LAGRANGE GA
30240-4225
US

IV. Provider business mailing address

505 JENKINS ST
LAGRANGE GA
30240-4225
US

V. Phone/Fax

Practice location:
  • Phone: 706-884-6114
  • Fax: 706-884-6116
Mailing address:
  • Phone: 706-884-6114
  • Fax: 706-884-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. EDWARD LAMAR HUTTO SR.
Title or Position: CERTIFIED PROSTHETIST/ORTHOTIST
Credential: CPO
Phone: 706-884-6114