Provider Demographics
NPI:1588933964
Name:LIMBCARE PROSTHETICS & ORTHOTICS OF GEORGIA INC
Entity type:Organization
Organization Name:LIMBCARE PROSTHETICS & ORTHOTICS OF GEORGIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RODMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:CPO
Authorized Official - Phone:229-430-9778
Mailing Address - Street 1:1444 TIFT AVE N
Mailing Address - Street 2:SUITE A
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4618
Mailing Address - Country:US
Mailing Address - Phone:855-639-3202
Mailing Address - Fax:
Practice Address - Street 1:1444 TIFT AVE N
Practice Address - Street 2:SUITE A
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4618
Practice Address - Country:US
Practice Address - Phone:855-639-3202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier