Provider Demographics
NPI:1538494968
Name:PREMIER ORTHOPEDICS, PC
Entity Type:Organization
Organization Name:PREMIER ORTHOPEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:D
Authorized Official - Last Name:COTTEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:229-435-1458
Mailing Address - Street 1:2405 OSLER CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-0214
Mailing Address - Country:US
Mailing Address - Phone:229-435-1458
Mailing Address - Fax:229-317-2342
Practice Address - Street 1:2405 OSLER CT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-0214
Practice Address - Country:US
Practice Address - Phone:229-435-1458
Practice Address - Fax:229-317-2342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA208016568AMedicaid
GAGRP7887Medicare PIN