Prosthetic Care, LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

PROSTHETIC CARE, LLC

Practice address

1445 Old McDonough Hwy SE
Suite-A1
Conyers, GA 30094-5977

Phone

(770) 271-5581

Fax

(770) 271-5531

NPI assigned

Jul 26, 2007

Organization subpart

No

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

Authorized official

Name

Pallavi Chintapalli Nemani

Title

Compliance Officer

Phone

(512) 552-6311

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ProCare Prosthetics and Orthotics Doing business as

Locations

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674604800000",
    "number": "1497945455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4460 COMMERCE DR",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305183489",
            "telephone_number": "770-271-5581",
            "fax_number": "770-271-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 OLD MCDONOUGH HWY SE",
            "address_2": "SUITE-A1",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300945977",
            "telephone_number": "770-271-5581",
            "fax_number": "770-271-5531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSTHETIC CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-26",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A",
        "authorized_official_last_name": "NEMANI",
        "authorized_official_first_name": "PALLAVI",
        "authorized_official_middle_name": "CHINTAPALLI",
        "authorized_official_title_or_position": "COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "512-552-6311"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00678345A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProCare Prosthetics and Orthotics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ProCare Prosthetics and Orthotics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; 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.