Organization
ORTHOPOD 1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALPHONSO DEWAYNE BRYANT ORTHOTIST (OWNER)
(478) 476-0201
Entity
Organization
Contact information
Practice address
182 RILEY AVE STE B, MACON, GA 31204-0771
(478) 476-0201
Mailing address
182 RILEY AVE STE B, MACON, GA 31204-0771
(478) 476-0201
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
73
GA
Other
Enumeration date
05/06/2009
Last updated
05/13/2009
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