Healthcare Provider Details

I. General information

NPI: 1891145561
Provider Name (Legal Business Name): PARAGON SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 HOWELL MILL RD NW STE 250
ATLANTA GA
30327-4111
US

IV. Provider business mailing address

3280 HOWELL MILL RD NW STE 250
ATLANTA GA
30327-4111
US

V. Phone/Fax

Practice location:
  • Phone: 470-270-8978
  • Fax: 470-355-7133
Mailing address:
  • Phone: 470-270-8978
  • Fax: 470-355-7133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number56449
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number56449
License Number StateGA

VIII. Authorized Official

Name: CHARLES EDWARDS GARTEN
Title or Position: MD OWNER
Credential: MD
Phone: 470-270-8978