MEDICARE: PINNACLE ORTHOPAEDICS AND SPORTS MEDICINE

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	174400000X	Specialist

General Provider Information

NPI Number	:	1811039548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE ORTHOPAEDICS AND SPORTS MEDICINE

Provider Business Mailing Address
First Line	:	300 TOWER RD NE STE 101
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-9403
Country	:	US
Telephone Number	:	770-218-0219
Fax Number	:	770-218-9847

Provider Business Practice Location Address
First Line	:	705 DALLAS HWY STE 201
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-1243
Country	:	US
Telephone Number	:	770-456-1659
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LINDA TERHARK
Credential	:
Telephone Number	:	678-842-5425

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	08/22/2020

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Directions to “PINNACLE ORTHOPAEDICS AND SPORTS MEDICINE ” Practice Location

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