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General NPI Number Information
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NPI Number | 1265047005
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Entity Type | Organization
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Legal Business Name | ORTHOATLANTA, LLC
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 3929 PEACHTREE RD NE STE 250
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City | BROOKHAVEN
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State | GA
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Zip | 30319-3374
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Country | US
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Telephone | 404-352-1053
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Fax | 404-350-0840
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Provider Business Mailing Address
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Address Line | 900 CIRCLE 75 PKWY SE STE 1700
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City | ATLANTA
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State | GA
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Zip | 30339-3087
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Country | US
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Telephone | 770-953-6929
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | TEYANNA CONYERS
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Credential |
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Telephone | 678-680-4945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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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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