MEDICARE: JADE FUTCH

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	:	1689423337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADE FUTCH

Provider Business Mailing Address
First Line	:	3380 PEACHTREE RD NE UNIT 816
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1645
Country	:	US
Telephone Number	:	856-420-1333
Fax Number	:

Provider Business Practice Location Address
First Line	:	3380 PEACHTREE RD NE UNIT 816
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1645
Country	:	US
Telephone Number	:	856-420-1333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2024
Last Update Date	:	05/15/2024

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Directions to “ JADE FUTCH ” Practice Location

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