Provider Demographics
NPI:1063481505
Name:ABLE PROSTHETIC CARE, INC.
Entity Type:Organization
Organization Name:ABLE PROSTHETIC CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOLZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-922-5540
Mailing Address - Street 1:2141 EASTVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-5756
Mailing Address - Country:US
Mailing Address - Phone:770-922-5540
Mailing Address - Fax:770-922-8535
Practice Address - Street 1:2141 EASTVIEW PKWY
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5756
Practice Address - Country:US
Practice Address - Phone:770-922-5540
Practice Address - Fax:770-922-8535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACP2676224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1250340001Medicare ID - Type Unspecified