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General NPI Number Information
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NPI Number | 1578590972
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Entity Type | Organization
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Legal Business Name | AMPUTEE PROSTHETIC CLINIC, CO.
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 805 CAMDEN WAY
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City | TIFTON
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State | GA
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Zip | 31794-8093
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Country | US
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Telephone | 229-387-6600
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Fax | 229-387-7800
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Provider Business Mailing Address
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Address Line | 4900 MERCER UNIVERSITY DR
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City | MACON
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State | GA
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Zip | 31210-6239
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Country | US
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Telephone | 478-474-5678
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Fax | 478-474-5018
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Authorized Official
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Title or Position | OFF. MANAGER/OWNER
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Name | MRS. PAM S YOUNG
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Credential |
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Telephone | 478-474-5678
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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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