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General NPI Number Information
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NPI Number | 1083798458
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Entity Type | Organization
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Legal Business Name | ORTHO-P.O.D. INC.
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1190 FIVE FORKS TRICKUM RD SUITE 5
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-9392
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Country | US
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Telephone | 770-995-4310
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Fax | 770-995-4320
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Provider Business Mailing Address
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Address Line | 1190 FIVE FORKS TRICKUM RD SUITE 5
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-9392
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Country | US
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Telephone | 770-995-4310
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Fax | 770-995-4320
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RONNIE TINIO LLENA
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Credential | CO
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Telephone | 770-995-4310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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