MEDICARE: ALBANY BONE & JOINT CLINIC, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	041172	GA

General Provider Information

NPI Number	:	1598942773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBANY BONE & JOINT CLINIC, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 407
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31702-0407
Country	:	US
Telephone Number	:	229-883-4707
Fax Number	:	229-883-1189

Provider Business Practice Location Address
First Line	:	2726 LEDO RD
Second Line	:	SUITE 2
City	:	ALBANY
State	:	GA
Zip	:	31707-7622
Country	:	US
Telephone Number	:	229-878-4321
Fax Number	:	229-878-5156

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	PAUL A. MICHAS
Credential	:	M.D.
Telephone Number	:	229-883-4707

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	01/30/2008

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