1881835817 NPI number — AUGUSTA PROSTHETICS AND ORTHOTICS, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881835817 NPI number — AUGUSTA PROSTHETICS AND ORTHOTICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUGUSTA PROSTHETICS AND ORTHOTICS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AUGUSTA ORTHOTICS AND PROSTHETICS, INC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881835817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2068 WRIGHTSBORO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-733-8878
Provider Business Mailing Address Fax Number:
706-733-4434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 NORTH COBB STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLEDGEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-453-7327
Provider Business Practice Location Address Fax Number:
478-451-0741
Provider Enumeration Date:
03/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RICE
Authorized Official First Name:
ROY
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
706-733-8878

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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