Provider Demographics
NPI:1508811225
Name:CENTRAL ORTHOTICS, INC.
Entity Type:Organization
Organization Name:CENTRAL ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPO
Authorized Official - Phone:229-891-2636
Mailing Address - Street 1:304 A SUNSET CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768
Mailing Address - Country:US
Mailing Address - Phone:229-891-2636
Mailing Address - Fax:229-228-0049
Practice Address - Street 1:304 - A SUNSET CIRCLE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768
Practice Address - Country:US
Practice Address - Phone:229-891-2636
Practice Address - Fax:229-228-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000135913FMedicaid
GA000135913FMedicaid