Healthcare Provider Details

I. General information

NPI: 1508597741
Provider Name (Legal Business Name): ORTHO SPORT AND SPINE PHYSICIANS POOLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 PIPEMAKERS CIR STE 100
POOLER GA
31322-4164
US

IV. Provider business mailing address

5788 ROSWELL RD
ATLANTA GA
30328-4904
US

V. Phone/Fax

Practice location:
  • Phone: 800-678-4611
  • Fax: 770-234-5326
Mailing address:
  • Phone: 678-752-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FAITH A BELTZHOOVER
Title or Position: REVENUE CYCLE MANAGEMENT DIRECTOR
Credential:
Phone: 800-678-4611