Provider Demographics
NPI:1265089478
Name:ALLIANCE PROSTHETICS AND ORTHOTICS
Entity type:Organization
Organization Name:ALLIANCE PROSTHETICS AND ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:AUYER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:678-936-2386
Mailing Address - Street 1:1241 FRIENDSHIP RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-5609
Mailing Address - Country:US
Mailing Address - Phone:770-679-3090
Mailing Address - Fax:
Practice Address - Street 1:655 JESSE JEWELL PKWY SE STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3854
Practice Address - Country:US
Practice Address - Phone:770-679-3090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE PROSTHETICS AND ORTHOTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-22
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier