Provider Demographics
NPI:1164889580
Name:GEORGIA BRACING CENTER
Entity Type:Organization
Organization Name:GEORGIA BRACING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUITRAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-206-4904
Mailing Address - Street 1:2021 N SLAPPEY BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1001
Mailing Address - Country:US
Mailing Address - Phone:800-206-4904
Mailing Address - Fax:
Practice Address - Street 1:2021 N SLAPPEY BLVD
Practice Address - Street 2:STE 203
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1001
Practice Address - Country:US
Practice Address - Phone:800-206-4904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-16
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies