Healthcare Provider Details

I. General information

NPI: 1194981282
Provider Name (Legal Business Name): PATRICK SEAN PRICE CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 TECHNOLOGY DR SUITE 4
MARTINEZ GA
30907-6800
US

IV. Provider business mailing address

4810 TECHNOLOGY DR SUITE 4
MARTINEZ GA
30907-6800
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-5491
  • Fax: 706-922-5494
Mailing address:
  • Phone: 706-922-5491
  • Fax: 706-922-5494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number46
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number000046
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number000046
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: