Provider Demographics
NPI:1194815175
Name:PINNACLE ORTHOPAEDICS & SPORTS MEDICINE SPECIALISTS LLC
Entity Type:Organization
Organization Name:PINNACLE ORTHOPAEDICS & SPORTS MEDICINE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-427-5717
Mailing Address - Street 1:300 TOWER RD NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-9404
Mailing Address - Country:US
Mailing Address - Phone:770-427-5717
Mailing Address - Fax:770-429-6503
Practice Address - Street 1:300 TOWER RD NE
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9404
Practice Address - Country:US
Practice Address - Phone:770-427-5717
Practice Address - Fax:770-429-6503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174400000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP 2867Medicare ID - Type Unspecified