Healthcare Provider Details

I. General information

NPI: 1316933617
Provider Name (Legal Business Name): ALABAMA ORTHOTICS & PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 HIGHWAY 72 W
CORINTH MS
38834-9398
US

IV. Provider business mailing address

1501 CLIFF GOOKIN BLVD
TUPELO MS
38801-6401
US

V. Phone/Fax

Practice location:
  • Phone: 662-396-4670
  • Fax: 662-396-4677
Mailing address:
  • Phone: 662-396-4670
  • Fax: 662-396-4677

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. JERRY O. SWANSON
Title or Position: PRESIDENT
Credential: C.P., L.P.
Phone: 256-536-5625