Organization
PEACHSTATE PROSTHETICS AND ORTHOTICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN G SEMMES LCPO (PRESIDENT)
(706) 400-5750
Entity
Organization
Contact information
Practice address
178 BRACKETTS WAY STE 3, BLAIRSVILLE, GA 30512-2984
(706) 400-5750
(706) 400-5751
Mailing address
178 BRACKETTS WAY STE 3, BLAIRSVILLE, GA 30512-2984
(706) 400-5750
(706) 400-5751
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000690852A
—
GA
01
—
1003810748
NPI
GA
01
—
20010497912
STATE SALES TAX ID
GA
01
—
LPO#000004
COMPOSITE MEDICAL BOARD
GA
Enumeration date
06/10/2005
Last updated
09/23/2019
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