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General NPI Number Information
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NPI Number | 1902864754
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Entity Type | Organization
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Legal Business Name | THOMASVILLE ORTHOPEDIC CENTER, PC
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 100 MIMOSA DR
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City | THOMASVILLE
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State | GA
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Zip | 31792
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Country | US
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Telephone | 229-226-9141
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Fax | 229-228-0637
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Provider Business Mailing Address
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Address Line | PO BOX 2968
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City | THOMASVILLE
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State | GA
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Zip | 31799-2968
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Country | US
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Telephone | 229-226-9141
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Fax | 229-228-0637
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Authorized Official
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Title or Position | PRESIDENT
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Name | FREDERICK R NUSBICKEL
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Credential | MD
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Telephone | 229-226-9144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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