Healthcare Provider Details

I. General information

NPI: 1700090008
Provider Name (Legal Business Name): NORTHEAST GEORGIA INSTITUTE OF BONE & JOINT SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3018 FALLS ROAD SUITE B
TOCCOA GA
30577
US

IV. Provider business mailing address

PO BOX 250
TOCCOA GA
30577-1404
US

V. Phone/Fax

Practice location:
  • Phone: 706-297-7877
  • Fax: 706-297-7865
Mailing address:
  • Phone: 706-297-7877
  • Fax: 706-297-7865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAMES FORDYCE
Title or Position: CEO
Credential: M.D.
Phone: 706-297-7877