Provider Demographics
NPI:1538322821
Name:NEW LIFE PROSTHETICS OF GEORGIA INC.
Entity Type:Organization
Organization Name:NEW LIFE PROSTHETICS OF GEORGIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-922-5491
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:APPLING
Mailing Address - State:GA
Mailing Address - Zip Code:30802-0309
Mailing Address - Country:US
Mailing Address - Phone:706-922-5491
Mailing Address - Fax:
Practice Address - Street 1:4810 TECHNOLOGY DR
Practice Address - Street 2:4
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-6800
Practice Address - Country:US
Practice Address - Phone:706-922-5491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies