Healthcare Provider Details

I. General information

NPI: 1457285330
Provider Name (Legal Business Name): ORTHOCARE GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6564 PROFESSIONAL PL STE A
RIVERDALE GA
30274-2588
US

IV. Provider business mailing address

33 UPPER RIVERDALE RD SW STE 121
RIVERDALE GA
30274-2642
US

V. Phone/Fax

Practice location:
  • Phone: 470-751-4610
  • Fax: 678-792-4787
Mailing address:
  • Phone: 470-751-4610
  • Fax: 678-792-4787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY N GHATTAS
Title or Position: CEO/OWNER
Credential: MD
Phone: 979-574-4619