Provider Demographics
NPI:1790100881
Name:ATLANTIC PROSTHETICS & ORTHOTICS, LLC
Entity Type:Organization
Organization Name:ATLANTIC PROSTHETICS & ORTHOTICS, LLC
Other - Org Name:CRCR OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:919-945-0215
Mailing Address - Street 1:200 TIMBERHILL PL
Mailing Address - Street 2:STE. 203
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1596
Mailing Address - Country:US
Mailing Address - Phone:919-945-0215
Mailing Address - Fax:919-945-0220
Practice Address - Street 1:2709 BLUE RIDGE RD
Practice Address - Street 2:STE. 220
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6462
Practice Address - Country:US
Practice Address - Phone:919-882-0020
Practice Address - Fax:919-784-4613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment