Provider Demographics
NPI:1235405747
Name:PINNACLE ORTHOPAEDICS & SPORTS MEDICINE SPECIA
Entity Type:Organization
Organization Name:PINNACLE ORTHOPAEDICS & SPORTS MEDICINE SPECIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:CAO
Authorized Official - Phone:770-429-7741
Mailing Address - Street 1:300 TOWER ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-9403
Mailing Address - Country:US
Mailing Address - Phone:770-427-5717
Mailing Address - Fax:770-514-5040
Practice Address - Street 1:1000 CHASTAIN ROAD
Practice Address - Street 2:BUILDING II
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-0000
Practice Address - Country:US
Practice Address - Phone:770-427-5717
Practice Address - Fax:770-514-5040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE ORTHOPAEDICS & SPORTS MEDICINE SPECIALISTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31591207XX0005X
GA64509207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty