Organization
ORTHOSQUAD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY C SMITH (PRESIDENT)
(404) 790-2922
Entity
Organization
Contact information
Practice address
1031 CAMBRIDGE SQ STE B, ALPHARETTA, GA 30009-1869
(404) 790-2922
(866) 576-7014
Mailing address
980 BIRMINGHAM RD STE 501-299, MILTON, GA 30004-4417
(404) 790-2922
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
47
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003169168A
—
GA
05
—
003169168B
—
GA
Enumeration date
08/26/2014
Last updated
01/30/2020
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