Healthcare Provider Details

I. General information

NPI: 1639994114
Provider Name (Legal Business Name): AICA ORTHOPEDICS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 SYCAMORE DR
DECATUR GA
30030-1644
US

IV. Provider business mailing address

2253 NORTHWEST PKWY SE
MARIETTA GA
30067-8764
US

V. Phone/Fax

Practice location:
  • Phone: 678-701-2225
  • Fax: 678-206-0502
Mailing address:
  • Phone: 678-701-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SPENCER MORGAN
Title or Position: INSURANCE COLLECTIONS MANAGER
Credential:
Phone: 678-701-2225