Provider Demographics
NPI:1992974448
Name:ATLANTA PROSTHETICS & ORTHOTICS
Entity type:Organization
Organization Name:ATLANTA PROSTHETICS & ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NABORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-636-0321
Mailing Address - Street 1:1124 N PARK ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-2229
Mailing Address - Country:US
Mailing Address - Phone:770-214-8282
Mailing Address - Fax:770-214-8214
Practice Address - Street 1:1124 N PARK ST
Practice Address - Street 2:SUITE D
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-2229
Practice Address - Country:US
Practice Address - Phone:770-214-8282
Practice Address - Fax:770-214-8214
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTA PROSTHETICS & ORTHOTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier