Provider Demographics
NPI:1881678522
Name:STUBBS PROSTHETICS & ORTHOTICS, INC.
Entity Type:Organization
Organization Name:STUBBS PROSTHETICS & ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:STUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:423-698-1778
Mailing Address - Street 1:5715 UPTAIN RD STE 5800
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5655
Mailing Address - Country:US
Mailing Address - Phone:423-698-1778
Mailing Address - Fax:423-698-1741
Practice Address - Street 1:1213 BROADRICK DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2504
Practice Address - Country:US
Practice Address - Phone:706-259-4563
Practice Address - Fax:706-259-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3541423Medicaid
GA483452058BOtherMEDICAID
TN3141176OtherBCBST
TN3141176OtherBCBST