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General NPI Number Information
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NPI Number | 1588922306
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Entity Type | Organization
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Legal Business Name | GEORGIA ORTHOPEDICS AND SPORTS MEDICINE,LLC
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 4181 HOSPITAL DR NE
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City | COVINGTON
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State | GA
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Zip | 30014-2541
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Country | US
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Telephone | 770-788-6534
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Fax | 770-788-7658
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Provider Business Mailing Address
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Address Line | 4181 HOSPITAL DR NE SUITE 204
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City | COVINGTON
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State | GA
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Zip | 30014-2541
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Country | US
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Telephone | 770-788-6534
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Fax | 770-788-7658
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ANGELA ROBERTS
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Credential |
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Telephone | 770-788-6534
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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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