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General NPI Number Information
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NPI Number | 1669075297
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Entity Type | Organization
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Legal Business Name | ORTHO SPORT AND SPINE PHYSICIANS DAWSONVILLE
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 02/22/2021
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Provider Practice Location Address
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Address Line | 5959 HIGHWAY 53 E STE 250
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City | DAWSONVILLE
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State | GA
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Zip | 30534-9510
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Country | US
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Telephone | 678-752-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 5788 ROSWELL RD STE 100
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City | ATLANTA
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State | GA
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Zip | 30328-4904
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Country | US
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Telephone | 678-752-7246
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Fax |
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Authorized Official
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Title or Position | BILLING DIRECTOR
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Name | FAITH A BELTZHOOVER
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Credential |
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Telephone | 678-752-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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