Organization
MBA DIABETIC FOOTWEAR SOLUTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAURICE SYNTEL BYRD (CEO)
(912) 352-8031
Entity
Organization
Contact information
Practice address
4395 OGEECHEE RD, STE 209, SAVANNAH, GA 31405-1249
(912) 335-8934
Mailing address
7505 WATERS AVE, STE E-4, SAVANNAH, GA 31406-3825
(912) 352-8031
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
1071579
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
079591530A
—
GA
05
—
079591530B
—
GA
05
—
DE3140
—
SC
Enumeration date
08/14/2008
Last updated
06/18/2010
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