Provider Demographics
NPI:1588492425
Name:ALLIANCE PROSTHETICS AND ORTHOTICS
Entity type:Organization
Organization Name:ALLIANCE PROSTHETICS AND ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:AUYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-379-3090
Mailing Address - Street 1:1241 FRIENDSHIP RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-5609
Mailing Address - Country:US
Mailing Address - Phone:770-679-3090
Mailing Address - Fax:770-679-3142
Practice Address - Street 1:1864 AUBURN ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019
Practice Address - Country:US
Practice Address - Phone:770-679-3090
Practice Address - Fax:770-679-3142
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE PROSTHETICS AND ORTHOTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier