Provider Demographics
NPI:1477039741
Name:ATLANTA KNEE AND SHOULDER CLINIC PC
Entity Type:Organization
Organization Name:ATLANTA KNEE AND SHOULDER CLINIC PC
Other - Org Name:ATLANTA KNEE AND SHOULDER, P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:770-389-9005
Mailing Address - Street 1:3200 DOWNWOOD CIR NW STE 410
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1624
Mailing Address - Country:US
Mailing Address - Phone:404-352-4779
Mailing Address - Fax:404-351-0551
Practice Address - Street 1:3200 DOWNWOOD CIR NW STE 410
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327
Practice Address - Country:US
Practice Address - Phone:404-352-4779
Practice Address - Fax:404-351-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA033254OtherGEORGIA MEDICAL LICENSE