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General NPI Number Information
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NPI Number | 1669403291
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Entity Type | Organization
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Legal Business Name | BRUNSWICK ORTHOTICS & PROSTHETICS, INC.
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 3501 ALTAMA AVE
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City | BRUNSWICK
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State | GA
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Zip | 31520-3629
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Country | US
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Telephone | 912-261-8117
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Fax | 912-261-8301
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Provider Business Mailing Address
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Address Line | 3501 ALTAMA AVE
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City | BRUNSWICK
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State | GA
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Zip | 31520-3629
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Country | US
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Telephone | 912-261-8117
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Fax | 912-261-8301
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Authorized Official
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Title or Position | C.P.O.
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Name | MR. DAVID SHANNON THOMPSON
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Credential | C.P.O.
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Telephone | 912-261-8117
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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 | GA
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