Provider Demographics
NPI:1326295445
Name:LIMBCARE PROSTHETICS AND ORTHOTICS OF GEORGIA INC
Entity Type:Organization
Organization Name:LIMBCARE PROSTHETICS AND ORTHOTICS OF GEORGIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RODMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:CPO
Authorized Official - Phone:229-430-9778
Mailing Address - Street 1:2910 N ASHLEY ST STE K
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1759
Mailing Address - Country:US
Mailing Address - Phone:229-247-7551
Mailing Address - Fax:229-247-7561
Practice Address - Street 1:2910 N ASHLEY ST STE K
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1759
Practice Address - Country:US
Practice Address - Phone:229-247-7551
Practice Address - Fax:229-247-7561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACPO2284335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA207018229BMedicaid
GA5892570001OtherMEDICARE NUMBER
GA5892570001OtherMEDICARE NUMBER