MEDICARE: PINNACLE ORTHOPAEDICS & SPORTS MEDICINE SPECIALISTS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	65285	GA
2	207X00000X	Orthopaedic Surgery Physician	31591	GA

General Provider Information

NPI Number	:	1386908184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE ORTHOPAEDICS & SPORTS MEDICINE SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	300 TOWER ROAD
Second Line	:	SUITE 200
City	:	MARIETTA
State	:	GA
Zip	:	30060-9403
Country	:	US
Telephone Number	:	770-427-5717
Fax Number	:	770-514-6744

Provider Business Practice Location Address
First Line	:	4550 COBB PARKWAY NW
Second Line	:	SUITE 309G
City	:	ACWORTH
State	:	GA
Zip	:	30101-0000
Country	:	US
Telephone Number	:	678-213-5717
Fax Number	:	678-213-5723

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	DONNA L FISHER
Credential	:	CAO
Telephone Number	:	770-429-7741

Provider Enumeration Date	:	06/27/2012
Last Update Date	:	10/22/2012

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