Provider Demographics
NPI:1710941232
Name:AUGUSTA ORTHOTICS AND PROSTHETICS, INC
Entity Type:Organization
Organization Name:AUGUSTA ORTHOTICS AND PROSTHETICS, INC
Other - Org Name:AUGUSTA ORTHOTICS AND PROSTHETICS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:RICE
Authorized Official - Suffix:III
Authorized Official - Credentials:
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
Mailing Address - Country:US
Mailing Address - Phone:706-733-8878
Mailing Address - Fax:706-733-4434
Practice Address - Street 1:1000 HAWTHORNE AVE
Practice Address - Street 2:SUITE I
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2168
Practice Address - Country:US
Practice Address - Phone:706-850-5604
Practice Address - Fax:706-850-5819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20012475027335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00828253AMedicaid
SCDE1438Medicaid
GA1268170003Medicare NSC