Provider Demographics
NPI:1528017092
Name:ORTHOPRO SERVICES, LLC
Entity Type:Organization
Organization Name:ORTHOPRO SERVICES, LLC
Other - Org Name:DUBLIN ORTHOTICS AND PROSTHETICS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GATLIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:478-272-6522
Mailing Address - Street 1:2505 MOORE STATION RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2964
Mailing Address - Country:US
Mailing Address - Phone:478-272-6522
Mailing Address - Fax:478-272-3992
Practice Address - Street 1:2505 MOORE STATION RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2964
Practice Address - Country:US
Practice Address - Phone:478-272-6522
Practice Address - Fax:478-272-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000897234AMedicaid
GA000897234AMedicaid