Provider Demographics
NPI:1083798458
Name:ORTHO-P.O.D. INC.
Entity Type:Organization
Organization Name:ORTHO-P.O.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:TINIO
Authorized Official - Last Name:LLENA
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:770-995-4310
Mailing Address - Street 1:1190 FIVE FORKS TRICKUM RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-9392
Mailing Address - Country:US
Mailing Address - Phone:770-995-4310
Mailing Address - Fax:770-995-4320
Practice Address - Street 1:1190 FIVE FORKS TRICKUM RD
Practice Address - Street 2:SUITE 5
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-9392
Practice Address - Country:US
Practice Address - Phone:770-995-4310
Practice Address - Fax:770-995-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00969328AMedicaid
GA4525220001Medicare NSC