Provider Demographics
NPI:1780863126
Name:ATHENS ORTHOTICS AND PROSTHETICS
Entity Type:Organization
Organization Name:ATHENS ORTHOTICS AND PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:ORTHOTISTS/PROSTHETI
Authorized Official - Phone:706-549-9709
Mailing Address - Street 1:590 N MILLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-3810
Mailing Address - Country:US
Mailing Address - Phone:706-549-9709
Mailing Address - Fax:706-549-0813
Practice Address - Street 1:590 N MILLEDGE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-3810
Practice Address - Country:US
Practice Address - Phone:706-549-9709
Practice Address - Fax:706-549-0813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACPO02403332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1325080001Medicare NSC