Organization
SOUTHERN ORTHOTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EVA WYNELL PEREZ (SOLE PROPRIETOR)
(229) 671-1161
Entity
Organization
Contact information
Practice address
1601 ASHLEY CENTER, UNIT 88, VALDOSTA, GA 31602-3055
(229) 671-1161
(888) 886-4887
Mailing address
1601 ASHLEY CENTER, UNIT 88, VALDOSTA, GA 31602-3055
(229) 671-1161
(888) 886-4887
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DMEPOS
PROVIDER NUMBER
—
Enumeration date
12/19/2005
Last updated
09/11/2025
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