Provider Demographics
NPI:1316325657
Name:PROSTHETIC CARE, LLC
Entity type:Organization
Organization Name:PROSTHETIC CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PALLAVI
Authorized Official - Middle Name:CHINTAPALLI
Authorized Official - Last Name:NEMANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-552-6311
Mailing Address - Street 1:4460 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3489
Mailing Address - Country:US
Mailing Address - Phone:770-271-5581
Mailing Address - Fax:770-271-5531
Practice Address - Street 1:1135 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2729
Practice Address - Country:US
Practice Address - Phone:770-271-5581
Practice Address - Fax:770-271-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000032335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00678345AMedicaid
GA931851232OtherDUN