Provider Demographics
NPI:1366655672
Name:NORTH GEORGIA ORTHOPAEDIC CENTER
Entity Type:Organization
Organization Name:NORTH GEORGIA ORTHOPAEDIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINCA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-889-7465
Mailing Address - Street 1:634 PEACHTREE PKWY
Mailing Address - Street 2:STE. 100
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9782
Mailing Address - Country:US
Mailing Address - Phone:770-889-7465
Mailing Address - Fax:770-781-9369
Practice Address - Street 1:634 PEACHTREE PKWY
Practice Address - Street 2:STE. 100
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9782
Practice Address - Country:US
Practice Address - Phone:770-889-7465
Practice Address - Fax:770-781-9369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADA9397OtherRAILROAD MEDICARE
GAGRP6085Medicare PIN