MEDICARE: ADVANCED ORTHOPAEDIC SERVICES

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	261QP2000X	Physical Therapy Clinic/Center	054621LGB	GA

General Provider Information

NPI Number	:	1457487548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED ORTHOPAEDIC SERVICES

Provider Business Mailing Address
First Line	:	3581 OLD IVY LN NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-4513
Country	:	US
Telephone Number	:	404-261-0328
Fax Number	:	404-842-0878

Provider Business Practice Location Address
First Line	:	3581 OLD IVY LN NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-4513
Country	:	US
Telephone Number	:	404-261-0328
Fax Number	:	404-842-0878

Authorized Official
Title or Position	:	CEO
Name	:	MARTHA V CARSON
Credential	:
Telephone Number	:	404-261-0328

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	08/22/2020

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