Provider Demographics
NPI:1174662605
Name:MULTI SPORT ORTHOTICS
Entity Type:Organization
Organization Name:MULTI SPORT ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:CO, ATC
Authorized Official - Phone:770-500-3996
Mailing Address - Street 1:3300 NORTHEAST EXPY NE
Mailing Address - Street 2:BLDG 8, SUITE B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3932
Mailing Address - Country:US
Mailing Address - Phone:770-500-3996
Mailing Address - Fax:
Practice Address - Street 1:3300 NORTHEAST EXPY NE
Practice Address - Street 2:BLDG 8, SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-3932
Practice Address - Country:US
Practice Address - Phone:770-500-3996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3712222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3907640001Medicare NSC