=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780819409
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | O'BRIEN ORTHOPEDICS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2009
-----------------------------------------------------
Last Update Date | 04/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 MEDICAL DR NE SUITE 304
-----------------------------------------------------
City | CARTERSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30121-8005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-721-6800
-----------------------------------------------------
Fax | 678-721-6803
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 HINES RD NE SUITE 4
-----------------------------------------------------
City | CALHOUN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30701-9374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-624-9494
-----------------------------------------------------
Fax | 706-624-9191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PRESIDENT
-----------------------------------------------------
Name | AARON J SORENSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-542-0897
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | 000011
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------