Provider Demographics
NPI:1255897419
Name:PEDIATRIC MOBILITY INNOVATIONS
Entity type:Organization
Organization Name:PEDIATRIC MOBILITY INNOVATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-399-1142
Mailing Address - Street 1:3114 AUGUSTA TECH DRIVE SUITE 404
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906
Mailing Address - Country:US
Mailing Address - Phone:706-496-3174
Mailing Address - Fax:
Practice Address - Street 1:3114 AUGUSTA TECH DRIVE SUITE 404
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906
Practice Address - Country:US
Practice Address - Phone:706-496-3174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies