Healthcare Provider Details

I. General information

NPI: 1568799302
Provider Name (Legal Business Name): ROSENBAUM ORTHOPAEDICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 10/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 PLAZA AVE
EASTMAN GA
31023-6788
US

IV. Provider business mailing address

PO BOX 4128
EASTMAN GA
31023-4128
US

V. Phone/Fax

Practice location:
  • Phone: 478-374-2490
  • Fax: 478-374-0337
Mailing address:
  • Phone: 478-374-2490
  • Fax: 478-374-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MIKE HESTER
Title or Position: CFO
Credential:
Phone: 478-448-4050