=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124071105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL ORTHOTICS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 01/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221B REMINGTON AVE
-----------------------------------------------------
City | THOMASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31792-5576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-228-1085
-----------------------------------------------------
Fax | 229-228-0049
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 221B REMINGTON AVE
-----------------------------------------------------
City | THOMASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31792-5577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-228-1085
-----------------------------------------------------
Fax | 229-228-0049
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RICHARD C. WILLIAMS JR.
-----------------------------------------------------
Credential | C.P.O.
-----------------------------------------------------
Telephone | 229-228-1085
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------