Provider Demographics
NPI:1336456748
Name:ATLANTA PROSTHETICS & ORTHOTICS THERAPY DIVISION,LLC
Entity Type:Organization
Organization Name:ATLANTA PROSTHETICS & ORTHOTICS THERAPY DIVISION,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:404-636-0321
Mailing Address - Street 1:59 EXECUTIVE PARK S
Mailing Address - Street 2:SUITE 4100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2208
Mailing Address - Country:US
Mailing Address - Phone:404-636-0321
Mailing Address - Fax:404-636-8884
Practice Address - Street 1:59 EXECUTIVE PARK S
Practice Address - Street 2:SUITE 4100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2208
Practice Address - Country:US
Practice Address - Phone:404-636-0321
Practice Address - Fax:404-636-8884
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTA PROSTHETICS & ORTHOTICS,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000130261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation