=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407715980
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STAR ORTHOPEDICS AND SPINE OF MACON LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2026
-----------------------------------------------------
Last Update Date | 01/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 S HOUSTON LAKE RD
-----------------------------------------------------
City | WARNER ROBINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31088-6392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-449-0925
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1020 W OAK ST STE A
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34741-4113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-699-6373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JORDAN KUPPINGER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-699-6373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------