Healthcare Provider Details

I. General information

NPI: 1417237694
Provider Name (Legal Business Name): ORTHOPRO SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 HEMLOCK ST SUITE 100A
MACON GA
31201-4200
US

IV. Provider business mailing address

458 HEMLOCK ST SUITE 100A
MACON GA
31201-4200
US

V. Phone/Fax

Practice location:
  • Phone: 478-742-0212
  • Fax: 478-742-0236
Mailing address:
  • Phone: 478-742-0212
  • Fax: 478-742-0236

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. RYAN GATLIN
Title or Position: MANAGING MEMBER
Credential: CPO
Phone: 478-742-0212