Provider Demographics
NPI:1730246653
Name:UNITED ARTIFICIAL LIMB
Entity type:Organization
Organization Name:UNITED ARTIFICIAL LIMB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:LCPO
Authorized Official - Phone:770-345-6899
Mailing Address - Street 1:95 HICKORY SPRINGS IND DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-7933
Mailing Address - Country:US
Mailing Address - Phone:770-345-6899
Mailing Address - Fax:770-345-7341
Practice Address - Street 1:95 HICKORY SPRINGS IND DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-7933
Practice Address - Country:US
Practice Address - Phone:770-345-6899
Practice Address - Fax:770-345-7341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X
GA12335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000377308AMedicaid
GA000377308AMedicaid