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1518096122 NPI number — DOMINION ORTHOPAEDIC CLINIC, LLC

NPI Number: 1518096122
Health Care Provider/Practitioner: DOMINION ORTHOPAEDIC CLINIC, LLC

Information about “1518096122” NPI (DOMINION ORTHOPAEDIC CLINIC, LLC) exists in 1518096122 in HTML format HTML  |  1518096122 in plain Text format TXT  |  1518096122 in PDF (Portable Document Format) PDF  |  1518096122 in an XML format XML  formats.

NPI Number : 1518096122 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1518096122",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DOMINION ORTHOPAEDIC CLINIC, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5555 PEACHTREE DUNWOODY RD NE",
    "SecondLineMailingAddress": "SUITE 215",
    "MailingAddressCityName": "ATLANTA",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30342-1703",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-455-4009",
    "MailingAddressFaxNumber": "770-455-4065",
    "FirstLinePracticeLocationAddress": "6 CONCOURSE PKWY STE 260",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ATLANTA",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30328-6117",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-455-4009",
    "PracticeLocationAddressFaxNumber": "770-455-4065",
    "EnumerationDate": "03/02/2007",
    "LastUpdateDate": "01/04/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CLARK",
    "AuthorizedOfficialFirstName": "RUTH",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRACTICE ADMINISTRATOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "770-455-4009",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "332B00000X",
          "TaxonomyName": "Durable Medical Equipment & Medical Supplies",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "174400000X",
          "TaxonomyName": "Specialist",
          "LicenseNumber": "037539",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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