=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639491780
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOUCH LIFE CENTER - ATLANTA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2010
-----------------------------------------------------
Last Update Date | 05/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 260 PEACHTREE ST NW SUITE 2200
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30303-1202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-419-1304
-----------------------------------------------------
Fax | 866-846-3838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 260 PEACHTREE ST NW SUITE 2200
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30303-1202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-419-1304
-----------------------------------------------------
Fax | 866-846-3838
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. MARK FORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-388-8075
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------