Organization
CONCOURSE BRACING & ORTHOTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATTI A SELDERS-ROBINSON (BILLING MANAGER)
(678) 518-9533
Entity
Organization
Contact information
Practice address
2183 RAMBLEWOOD CIR, DECATUR, GA 30035-3644
(678) 518-9533
(678) 518-9583
Mailing address
PO BOX 420508, ATLANTA, GA 30342-0508
(678) 518-9533
(678) 518-9583
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52188205 001
BLUECROSS BLUESHIELD
GA
Enumeration date
01/24/2008
Last updated
01/24/2008
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