Provider Demographics
NPI:1972772325
Name:PUCKETT, DAVID M (LPO/CPO)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:PUCKETT
Suffix:
Gender:M
Credentials:LPO/CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6230
Mailing Address - Country:US
Mailing Address - Phone:912-354-7500
Mailing Address - Fax:912-357-7887
Practice Address - Street 1:5206 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6230
Practice Address - Country:US
Practice Address - Phone:912-354-7500
Practice Address - Fax:912-354-7887
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000028335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier