Provider Demographics
NPI:1760843650
Name:ALLIANCE PROSTHETICS AND ORTHOTICS
Entity Type:Organization
Organization Name:ALLIANCE PROSTHETICS AND ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:AUYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-936-2386
Mailing Address - Street 1:1241 FRIENDSHIP RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-5609
Mailing Address - Country:US
Mailing Address - Phone:770-679-3090
Mailing Address - Fax:770-679-3142
Practice Address - Street 1:1241 FRIENDSHIP RD STE 120
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-5609
Practice Address - Country:US
Practice Address - Phone:770-679-3090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA112335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier