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General NPI Number Information
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NPI Number | 1033919709
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Entity Type | Organization
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Legal Business Name | PHOENIX ORTHO INJURY SPINE AND EXTREMITY SURGERY CENTER
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 1805 PARKE PLAZA CIR STE 103
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3646
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Country | US
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Telephone | 678-892-5590
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Fax | 678-449-0102
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Provider Business Mailing Address
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Address Line | 1805 PARKE PLAZA CIR STE 103
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3646
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Country | US
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Telephone | 678-892-5590
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Fax |
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Authorized Official
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Title or Position | ASC DIRECTOR
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Name | RACHEL RENFRO
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Credential | NP
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Telephone | 706-267-0148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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