Healthcare Provider Details

I. General information

NPI: 1912346263
Provider Name (Legal Business Name): ORTHOPEDIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W MULBERRY BLVD STE 140
POOLER GA
31322-3507
US

IV. Provider business mailing address

4683 CHABOT DRIVE, # 200
PLEASANTON CA
94588
US

V. Phone/Fax

Practice location:
  • Phone: 912-478-5111
  • Fax: 912-748-6699
Mailing address:
  • Phone: 925-621-2902
  • Fax: 925-269-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number027815
License Number StateGA

VIII. Authorized Official

Name: DR. JOHN GEORGE
Title or Position: OWNER/CEO
Credential: M.D.
Phone: 912-748-5111