MEDICARE: ATL ORTHOPEDICS MEDICAL GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207XS0106X	Orthopaedic Hand Surgery Physician
2	207XS0117X	Orthopaedic Surgery of the Spine Physician
3	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician
4	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician
5	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1124784368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATL ORTHOPEDICS MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	4143 RANDALL CT NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-3711
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3885 PRINCETON LAKES WAY SW STE 306
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-7100
Country	:	US
Telephone Number	:	404-662-3585
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LATRICIA BASS
Credential	:
Telephone Number	:	404-662-3585

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	11/11/2021

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Directions to “ATL ORTHOPEDICS MEDICAL GROUP LLC ” Practice Location

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