MEDICARE: LIMBCARE PROSTHETICS AND ORTHOTICS OF GEORGIA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1184858169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIMBCARE PROSTHETICS AND ORTHOTICS OF GEORGIA INC

Provider Business Mailing Address
First Line	:	511 W FORSYTH ST
Second Line	:	SUITE A
City	:	AMERICUS
State	:	GA
Zip	:	31709-3465
Country	:	US
Telephone Number	:	229-924-1620
Fax Number	:	229-924-1623

Provider Business Practice Location Address
First Line	:	511 W FORSYTH ST
Second Line	:	SUITE A
City	:	AMERICUS
State	:	GA
Zip	:	31709-3465
Country	:	US
Telephone Number	:	229-924-1620
Fax Number	:	229-924-1623

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MR. JOHN P RODMAN
Credential	:	C.P.O.
Telephone Number	:	229-430-9778

Provider Enumeration Date	:	05/06/2009
Last Update Date	:	11/03/2010

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