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General NPI Number Information
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NPI Number | 1871398602
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Entity Type | Organization
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Legal Business Name | ORTHOCARE GEORGIA LLC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 33 UPPER RIVERDALE RD SW STE 121
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City | RIVERDALE
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State | GA
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Zip | 30274-2642
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Country | US
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Telephone | 404-323-4096
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Fax |
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Provider Business Mailing Address
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Address Line | 33 UPPER RIVERDALE RD SW STE 121
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City | RIVERDALE
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State | GA
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Zip | 30274-2642
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | TIMOTHY N GHATTAS
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Credential | MD
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Telephone | 979-574-4619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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