Healthcare Provider Details

I. General information

NPI: 1336055169
Provider Name (Legal Business Name): TREK HOLDINGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W MAIN ST STE C
THOMASTON GA
30286-3560
US

IV. Provider business mailing address

2410 HOG MOUNTAIN RD STE 307
WATKINSVILLE GA
30677-4850
US

V. Phone/Fax

Practice location:
  • Phone: 706-389-1260
  • Fax: 706-786-0797
Mailing address:
  • Phone: 706-389-1260
  • Fax: 706-786-0797

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: RYAN ANDREW DOUGHERTY
Title or Position: CEO
Credential: CPO, LPO
Phone: 706-389-1260