Kinetic Prosthetics & Medical Supply

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

KINETIC PROSTHETICS & MEDICAL SUPPLY

Practice address

3595 Hiram Douglasville Hwy Ste 102
Hiram, GA 30141-4963

Phone

(678) 653-8370

Fax

(404) 492-8885

NPI assigned

Apr 25, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Martina Cameron

Title

Ceo

Phone

(770) 756-7073

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591920000000",
    "number": "1285254656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3595 HIRAM DOUGLASVILLE HWY STE 102",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301414963",
            "telephone_number": "678-653-8370",
            "fax_number": "404-492-8885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3595 HIRAM DOUGLASVILLE HWY STE 102",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301414963",
            "telephone_number": "678-653-8370",
            "fax_number": "404-492-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINETIC PROSTHETICS & MEDICAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-25",
        "last_updated": "2020-06-12",
        "certification_date": "2020-06-12",
        "status": "A",
        "authorized_official_last_name": "CAMERON",
        "authorized_official_first_name": "MARTINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-756-7073"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMEPOS",
            "identifier": "7812720001",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Hiram, GA
• Providers in Hiram, GA by specialty
• Prosthetic/Orthotic Supplier in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.