Provider Demographics
NPI:1659405546
Name:THE BONE & JOINT ORTHOPAEDIC SURGERY CLINIC, P. C.
Entity Type:Organization
Organization Name:THE BONE & JOINT ORTHOPAEDIC SURGERY CLINIC, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:H
Authorized Official - Last Name:BARJA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:478-552-9402
Mailing Address - Street 1:620 SPARTA RD
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-1803
Mailing Address - Country:US
Mailing Address - Phone:478-552-9402
Mailing Address - Fax:478-552-0645
Practice Address - Street 1:620 SPARTA RD
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1803
Practice Address - Country:US
Practice Address - Phone:478-552-9402
Practice Address - Fax:478-552-0645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00703645BMedicaid
GA1165340001Medicare NSC
GAG26827Medicare UPIN
GA511G701111Medicare PIN