Provider Demographics
NPI:1093222945
Name:INTERVENTIONAL ORTHOPEDICS OF ATLANTA LLC
Entity Type:Organization
Organization Name:INTERVENTIONAL ORTHOPEDICS OF ATLANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-586-9390
Mailing Address - Street 1:1975 19TH ST APT 2046
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-6061
Mailing Address - Country:US
Mailing Address - Phone:303-586-9390
Mailing Address - Fax:303-586-9393
Practice Address - Street 1:371 E PACES FERRY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2372
Practice Address - Country:US
Practice Address - Phone:303-586-9390
Practice Address - Fax:303-586-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-01
Last Update Date:2018-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72947208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty