Organization
AMPUTEE PROSTHETIC CLINIC, CO.
Active
Other names
AMPUTEE PROSTHETIC CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAM S YOUNG (OFF. MANAGER/OWNER)
(478) 474-5678
Entity
Organization
Contact information
Practice address
805 CAMDEN WAY, TIFTON, GA 31794-8093
(229) 387-6600
(229) 387-7800
Mailing address
4900 MERCER UNIVERSITY DR, MACON, GA 31210-6239
(478) 474-5678
(478) 474-5018
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
408774069A
—
GA
01
—
6016598
DEPT. OF LABOR
GA
Enumeration date
06/28/2006
Last updated
01/19/2024
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