Healthcare Provider Details

I. General information

NPI: 1386023901
Provider Name (Legal Business Name): ORTHOATLANTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 NEWNAN CROSSING BYP SUITE 200
NEWNAN GA
30265-2323
US

IV. Provider business mailing address

354 NEWNAN CROSSING BYP SUITE 200
NEWNAN GA
30265-2323
US

V. Phone/Fax

Practice location:
  • Phone: 770-460-4747
  • Fax:
Mailing address:
  • Phone: 770-460-4747
  • Fax:

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: ADRIANNE CHAPMAN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 770-460-4747