Healthcare Provider Details

I. General information

NPI: 1679881148
Provider Name (Legal Business Name): KNEE WALKER RENTALS OF GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2010
Last Update Date: 09/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 JULIE CT
RIVERDALE GA
30296-2254
US

IV. Provider business mailing address

1251 JULIE CT
RIVERDALE GA
30296-2254
US

V. Phone/Fax

Practice location:
  • Phone: 678-858-5922
  • Fax: 888-789-4160
Mailing address:
  • Phone: 678-858-5922
  • Fax: 888-789-4160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. KAVIN K MCGEE
Title or Position: CEO
Credential:
Phone: 678-858-5922