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General NPI Number Information
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NPI Number | 1689736100
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Entity Type | Organization
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Legal Business Name | ATHENS BONE AND JOINT PC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 1010 PRINCE AVE SUITE 115 SOUTH
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City | ATHENS
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State | GA
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Zip | 30606-5805
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Country | US
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Telephone | 706-583-9000
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Fax | 706-353-6525
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Provider Business Mailing Address
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Address Line | 1010 PRINCE AVE SUITE 115 SOUTH
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City | ATHENS
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State | GA
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Zip | 30606-5805
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Country | US
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Telephone | 706-583-9000
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Fax | 706-353-6525
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN RICHARD DORRIS III
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Credential | MD
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Telephone | 706-583-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 040899
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License Number State | GA
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