Provider Demographics
NPI:1790101442
Name:ATLANTIC PROSTHETICS & ORTHOTICS, LLC
Entity Type:Organization
Organization Name:ATLANTIC PROSTHETICS & ORTHOTICS, LLC
Other - Org Name:CRC 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 1:1807 FORDHAM BLVD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2200
Practice Address - Country:US
Practice Address - Phone:919-595-9649
Practice Address - Fax:919-595-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment