Healthcare Provider Details

I. General information

NPI: 1568044758
Provider Name (Legal Business Name): ORTHOATLANTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4181 HOSPITAL DR NE STE 401
COVINGTON GA
30014-2541
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 678-766-8999
  • Fax:
Mailing address:
  • Phone: 770-953-6929
  • Fax: 770-953-6972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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