| NPI | 1073275780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEVON M PHILLIPS Owner 706-668-7657 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2021-10-11 |
| Last Update Date | 2021-10-11 |