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General NPI Number Information
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NPI Number | 1295916344
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Entity Type | Organization
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Legal Business Name | PREMIER ORTHOTICS & PROSTHETICS, INC
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 753 N INDIAN CREEK DR
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City | CLARKSTON
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State | GA
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Zip | 30021-2347
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Country | US
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Telephone | 404-292-4200
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Fax | 404-292-4247
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Provider Business Mailing Address
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Address Line | 753 N INDIAN CREEK DR
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City | CLARKSTON
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State | GA
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Zip | 30021-2347
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Country | US
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Telephone | 404-292-4200
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Fax | 404-292-4247
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MR. MELVIN DIXON
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Credential | CPO
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Telephone | 404-292-4200
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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 | 0078
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License Number State | GA
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