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NPI Code Detail

MEDICARE: SMYRNA ORTHOPAEDIC & SPORTS MEDICINE CENTER, PC

MEDICARE: SMYRNA ORTHOPAEDIC & SPORTS MEDICINE CENTER, PC
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
1261Q00000XClinic/Center018210GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740305721
Entity Type Code : Organization
Provider Name (Legal Business Name) : SMYRNA ORTHOPAEDIC & SPORTS MEDICINE CENTER, PC
Provider Business Mailing Address
First Line : 582 CONCORD RD SE STE C
Second Line :
City : SMYRNA
State : GA
Zip : 30082-2616
Country : US
Telephone Number : 770-436-5484
Fax Number : 770-438-7299
Provider Business Practice Location Address
First Line : 582 CONCORD RD SE STE C
Second Line :
City : SMYRNA
State : GA
Zip : 30082-2616
Country : US
Telephone Number : 770-436-5484
Fax Number : 770-438-7299
Authorized Official
Title or Position : PRESIDENT
Name : DR. ANTHONY CABOT
Credential : M.D.
Telephone Number : 770-436-5484
Provider Enumeration Date : 03/20/2007
Last Update Date : 08/22/2020

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