Provider Demographics
NPI:1568781631
Name:BARBOUR ORTHOPAEDICS & SPORTS MEDICINE PC
Entity Type:Organization
Organization Name:BARBOUR ORTHOPAEDICS & SPORTS MEDICINE PC
Other - Org Name:BARBOUR ORTHOPAEDICS & SPINE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-480-9330
Mailing Address - Street 1:3240 NORTHEAST EXPY NE STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4003
Mailing Address - Country:US
Mailing Address - Phone:404-480-4330
Mailing Address - Fax:404-480-4330
Practice Address - Street 1:3240 NORTHEAST EXPY NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4003
Practice Address - Country:US
Practice Address - Phone:404-480-4330
Practice Address - Fax:404-480-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051908207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty