Healthcare Provider Details

I. General information

NPI: 1871713032
Provider Name (Legal Business Name): OBRIEN ORTHOPEDIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6490 HIGHWAY 72
ATHENS AL
35645
US

IV. Provider business mailing address

6490 HIGHWAY 72
ATHENS AL
35645
US

V. Phone/Fax

Practice location:
  • Phone: 256-757-2550
  • Fax: 256-757-5552
Mailing address:
  • Phone: 256-757-2550
  • Fax: 256-757-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES C OBRIEN
Title or Position: PRESIDENT
Credential: MD
Phone: 256-757-2550