Organization
WOOTEN PROSTHETICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAN L WOOTEN CP (OWNER/CEO)
(770) 991-7128
Entity
Organization
Contact information
Practice address
203 MEDICAL WAY, SUITE B, RIVERDALE, GA 30274-2517
(770) 991-7128
(770) 991-7130
Mailing address
203 MEDICAL WAY, SUITE B, RIVERDALE, GA 30274-2517
(770) 991-7128
(770) 991-7130
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
N/A
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00317204A
—
GA
Enumeration date
06/22/2006
Last updated
09/12/2013
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