Provider Demographics
NPI:1508811100
Name:AUGUSTA ORTHOTICS AND PROSTHETICS INC
Entity Type:Organization
Organization Name:AUGUSTA ORTHOTICS AND PROSTHETICS INC
Other - Org Name:AOPI
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMIN MANAGER CERTIFIED FITTER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILTON
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:706-733-8878
Mailing Address - Street 1:2068 WRIGHTSBORO RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4781
Mailing Address - Country:US
Mailing Address - Phone:706-733-8878
Mailing Address - Fax:706-733-4434
Practice Address - Street 1:2068 WRIGHTSBORO RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4781
Practice Address - Country:US
Practice Address - Phone:706-733-8878
Practice Address - Fax:706-733-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00828253AMedicaid
GA00828253AMedicaid