MEDICARE: ATLANTA OSTEOARTHRITIS CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
3	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1548892458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA OSTEOARTHRITIS CENTER LLC

Provider Business Mailing Address
First Line	:	2550 WINDY HILL RD SE STE 308
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8655
Country	:	US
Telephone Number	:	404-800-8533
Fax Number	:	470-600-4481

Provider Business Practice Location Address
First Line	:	2550 WINDY HILL RD SE STE 308
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8655
Country	:	US
Telephone Number	:	404-800-8533
Fax Number	:	470-600-4481

Authorized Official
Title or Position	:	DIRECTOR
Name	:	PHILLIP WOFFORD
Credential	:
Telephone Number	:	404-800-8533

Provider Enumeration Date	:	02/08/2020
Last Update Date	:	06/02/2023

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