Provider Demographics
NPI:1730102815
Name:ORTHO PODS & JAY PETERS ENTERPRISES INC
Entity Type:Organization
Organization Name:ORTHO PODS & JAY PETERS ENTERPRISES INC
Other - Org Name:ORTHO PODS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-781-9882
Mailing Address - Street 1:54 LUMPKIN CAMPGROUND RD S
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6196
Mailing Address - Country:US
Mailing Address - Phone:770-781-9882
Mailing Address - Fax:770-205-5926
Practice Address - Street 1:54 LUMPKIN CAMPGROUND RD S
Practice Address - Street 2:SUITE 140
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6196
Practice Address - Country:US
Practice Address - Phone:770-781-9882
Practice Address - Fax:770-205-5926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5532370001Medicare ID - Type Unspecified