Organization
ORTHO KICKZ OF GA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODERIC BAIN (OWNER)
(912) 777-8087
Entity
Organization
Contact information
Practice address
2126 E VICTORY DR, #228, SAVANNAH, GA 31404-3918
(912) 777-8087
Mailing address
2126 E VICTORY DR, #228, SAVANNAH, GA 31404-3918
(912) 777-8087
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
12/16/2014
Last updated
03/08/2016
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