Provider Demographics
NPI:1356317903
Name:ACADEMY ORTHOPEDICS LLC
Entity Type:Organization
Organization Name:ACADEMY ORTHOPEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KALSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-889-0891
Mailing Address - Street 1:318 TRIBBLE GAP RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2440
Mailing Address - Country:US
Mailing Address - Phone:770-889-0891
Mailing Address - Fax:770-889-0354
Practice Address - Street 1:318 TRIBBLE GAP RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2440
Practice Address - Country:US
Practice Address - Phone:770-889-0891
Practice Address - Fax:770-889-0354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028421207X00000X
GA035755207X00000X
GAG67930207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300025973DMedicaid
GA647209001OtherMEDICARE DME
GA300025973DMedicaid