Healthcare Provider Details

I. General information

NPI: 1144107038
Provider Name (Legal Business Name): ORTHOXPRESS OF GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 SANDY PLAINS RD STE 125
MARIETTA GA
30066-7221
US

IV. Provider business mailing address

206 OXFORD RD
NEW ALBANY MS
38652-3115
US

V. Phone/Fax

Practice location:
  • Phone: 770-824-9421
  • Fax: 770-824-9422
Mailing address:
  • Phone: 662-534-2298
  • Fax: 662-404-7028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KAYLA PENDER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 662-534-2227