OrganizationActive
Custom Prosthetic & Orthotic
NPI 1710147301 · Prosthetic/Orthotic Supplier · Clinton, MS
Provider details
- NPI number
- 1710147301
- Entity type
- Organization
- Primary specialty
- Prosthetic/Orthotic SupplierSuppliers
- Organization subpart
- No
- Authorized official
- Johnnie Owens, Owner President(601) 906-1024
Specialties & taxonomies
Suppliers
Practice location
801 E Northside Dr
Suite - D
Clinton, MS 39056-3663
Phone: (601) 906-1024
Approximate (ZIP-level) locationGet directions
Mailing address
801 E Northside Dr
Clinton, MS 39056-3663
Registry dates
- Enumerated
- 2008-06-17
- Last updated
- 2012-03-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.