Healthcare Provider Details

I. General information

NPI: 1144020348
Provider Name (Legal Business Name): ORTHO SPORT & SPINE PHYSICIANS OF NORTH CAROLINA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 PIEDMONT ROW DR S STE 410
CHARLOTTE NC
28287-3884
US

IV. Provider business mailing address

5788 ROSWELL RD
ATLANTA GA
30328-4904
US

V. Phone/Fax

Practice location:
  • Phone: 800-678-4611
  • Fax:
Mailing address:
  • Phone: 800-678-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FAITH BELTZHOOVER
Title or Position: RCM DIRECTOR
Credential:
Phone: 800-678-4611