Healthcare Provider Details

I. General information

NPI: 1609513464
Provider Name (Legal Business Name): PROSTHETIC CIRCLE OF CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 SEAWRIGHT DR
SAVANNAH GA
31406-2752
US

IV. Provider business mailing address

5507 ABERCORN ST STE 103
SAVANNAH GA
31405-6912
US

V. Phone/Fax

Practice location:
  • Phone: 912-421-3747
  • Fax:
Mailing address:
  • Phone: 912-421-3747
  • Fax: 912-428-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS VLAHOS
Title or Position: OWNER
Credential: DO
Phone: 912-421-3747