Provider Demographics
NPI:1972842045
Name:HYDE PROSTHETICS AND ORTHOTICS, LLC
Entity Type:Organization
Organization Name:HYDE PROSTHETICS AND ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-892-0170
Mailing Address - Street 1:290 COUNTRY CLUB DR STE 210
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9022
Mailing Address - Country:US
Mailing Address - Phone:770-892-0170
Mailing Address - Fax:770-892-0173
Practice Address - Street 1:290 COUNTRY CLUB DR STE 210
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9022
Practice Address - Country:US
Practice Address - Phone:770-892-0170
Practice Address - Fax:770-892-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier