Provider Demographics
NPI:1003974353
Name:ORTHOPEDIC SURGERY, P.C.
Entity Type:Organization
Organization Name:ORTHOPEDIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DENZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:678-957-3040
Mailing Address - Street 1:771 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4386
Mailing Address - Country:US
Mailing Address - Phone:678-957-3040
Mailing Address - Fax:678-957-3047
Practice Address - Street 1:771 OLD NORCROSS RD
Practice Address - Street 2:SUITE 155
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4386
Practice Address - Country:US
Practice Address - Phone:678-957-3040
Practice Address - Fax:678-957-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1119510002Medicare NSC