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General NPI Number Information
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NPI Number | 1376405399
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Entity Type | Organization
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Legal Business Name | PROSTHETIC ONE
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Dates
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Enumeration Date | 11/28/2025
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 5950 HUGH HOWELL RD STE C
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-2440
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Country | US
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Telephone | 770-674-0223
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Fax | 770-674-0221
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Provider Business Mailing Address
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Address Line | 5950 HUGH HOWELL RD STE C
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-2440
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Country | US
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Telephone | 770-674-0223
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Fax | 770-674-0221
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARCUS T BAKER
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Credential | CPO/L
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Telephone | 901-795-1776
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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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