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General NPI Number Information
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NPI Number | 1912958968
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Entity Type | Organization
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Legal Business Name | PREFERRED PROSTHETICS & ORTHOTICS, INC.
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | 3635 ALTAMA AVE
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City | BRUNSWICK
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State | GA
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Zip | 31520-3631
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Country | US
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Telephone | 912-262-2102
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Fax | 912-262-2105
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Provider Business Mailing Address
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Address Line | PO BOX 1096
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City | BRUNSWICK
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State | GA
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Zip | 31521-1096
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Country | US
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Telephone | 912-262-2102
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Fax | 912-262-2105
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Authorized Official
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Title or Position | CEO
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Name | RANDALL L SMITH
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Credential |
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Telephone | 912-262-2102
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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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