Provider Demographics
NPI:1396014528
Name:LIMBCARE PROSTHETICS & ORTHOTICS OF GA
Entity Type:Organization
Organization Name:LIMBCARE PROSTHETICS & ORTHOTICS OF GA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RODMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:CPO
Authorized Official - Phone:229-430-9778
Mailing Address - Street 1:1919 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1574
Mailing Address - Country:US
Mailing Address - Phone:229-789-0350
Mailing Address - Fax:229-789-0353
Practice Address - Street 1:1919 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1574
Practice Address - Country:US
Practice Address - Phone:229-789-0350
Practice Address - Fax:229-789-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier