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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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