Provider Demographics
NPI:1194750190
Name:ORTHOPAEDIC TECHNOLOGY SPECIALISTS INC
Entity type:Organization
Organization Name:ORTHOPAEDIC TECHNOLOGY SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:SR
Authorized Official - Credentials:BOCO
Authorized Official - Phone:404-215-9944
Mailing Address - Street 1:577 RALPH MCGILL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1110
Mailing Address - Country:US
Mailing Address - Phone:404-215-9944
Mailing Address - Fax:404-215-9160
Practice Address - Street 1:577 RALPH MCGILL BLVD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1110
Practice Address - Country:US
Practice Address - Phone:404-215-9944
Practice Address - Fax:404-215-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA090590LGS246Z00000X
332B00000X, 332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00929651AMedicaid
GA00929651CMedicaid
GA00929651CMedicaid