Organization
KINETIC PROSTHETICS & MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTINA CAMERON (CEO)
(770) 756-7073
Entity
Organization
Contact information
Practice address
3595 HIRAM DOUGLASVILLE HWY STE 102, HIRAM, GA 30141-4963
(678) 653-8370
(404) 492-8885
Mailing address
3595 HIRAM DOUGLASVILLE HWY STE 102, HIRAM, GA 30141-4963
(678) 653-8370
(404) 492-8885
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7812720001
DMEPOS
GA
Enumeration date
04/25/2020
Last updated
06/12/2020
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