1407810880 NPI number — GEORGIA PROSTHETICS, INC.

Table of content: (NPI 1407810880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407810880 NPI number — GEORGIA PROSTHETICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA PROSTHETICS, 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:
Provider Other Organization Name Type Code:
6
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:
1407810880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1024 N HIGHLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURFREESBORO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37130-2443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-648-2214
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
288 14TH ST NW STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30318-5360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-873-3725
Provider Business Practice Location Address Fax Number:
404-873-3724
Provider Enumeration Date:
04/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SORENSEN
Authorized Official First Name:
AARON
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
615-542-0897

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00040884A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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