Healthcare Provider Details

I. General information

NPI: 1053819854
Provider Name (Legal Business Name): ORTHOATLANTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 LEGENDS PL SE STE 890
ATLANTA GA
30339-4245
US

IV. Provider business mailing address

3100 INTERSTATE NORTH CIR SE STE 500
ATLANTA GA
30339-2296
US

V. Phone/Fax

Practice location:
  • Phone: 404-418-9090
  • Fax:
Mailing address:
  • Phone: 770-953-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL OCHAL
Title or Position: CEO
Credential:
Phone: 770-953-6829