Healthcare Provider Details

I. General information

NPI: 1083049464
Provider Name (Legal Business Name): ORTHOPAEDIC IME SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE SUITE 1075
ATLANTA GA
30308-2208
US

IV. Provider business mailing address

4279 ROSWELL RD NE SUITE 102-329
ATLANTA GA
30342-3769
US

V. Phone/Fax

Practice location:
  • Phone: 404-855-3339
  • Fax: 404-255-2170
Mailing address:
  • Phone: 404-855-3339
  • Fax: 404-255-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number029684
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number029684
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number029684
License Number StateGA

VIII. Authorized Official

Name: DR. ROBYSINA LOUISE JAMES
Title or Position: PRESIDENT
Credential: MD
Phone: 404-855-3339