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General NPI Number Information
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NPI Number | 1427924554
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Entity Type | Organization
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Legal Business Name | ORTHOXPRESS OF GEORGIA
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 104 N PARK DR STE 104
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1645
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Country | US
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Telephone | 470-944-5290
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Fax |
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Provider Business Mailing Address
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Address Line | 206 OXFORD RD
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City | NEW ALBANY
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State | MS
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Zip | 38652-3115
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Country | US
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Telephone | 662-534-2227
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER C BULLOCK
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Credential |
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Telephone | 662-534-2298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 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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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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