| NPI | 1376180257 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATRYCE GOLLIDAY CFO 770-309-2929 |
| 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 | 2019-12-10 |
| Last Update Date | 2019-12-10 |