Provider Demographics
NPI:1659144145
Name:ORTHO SPORT & SPINE PHYSICIANS OF ALABAMA
Entity Type:Organization
Organization Name:ORTHO SPORT & SPINE PHYSICIANS OF ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:INDHIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-374-8163
Mailing Address - Street 1:5788 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4241 LOMAC ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2879
Practice Address - Country:US
Practice Address - Phone:678-752-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty