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General NPI Number Information
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NPI Number | 1598950941
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Entity Type | Organization
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Legal Business Name | DOMINION ORTHOPAEDIC CLINIC, LLC
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 5555 PEACHTREE DUNWOODY RD NE # 215
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City | ATLANTA
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State | GA
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Zip | 30342-1703
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Country | US
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Telephone | 770-455-4009
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Fax |
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Provider Business Mailing Address
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Address Line | 3607 OLD CONEJO RD
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City | THOUSAND OAKS
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State | CA
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Zip | 91320-2123
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Country | US
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Telephone | 805-375-0800
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | JOHN FOSTER III
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Credential | M.D.
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Telephone | 770-455-4009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | AF3288328
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License Number State | GA
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