Provider Demographics
NPI:1659715803
Name:ORTHOSPORTS ATHENS, LLC
Entity Type:Organization
Organization Name:ORTHOSPORTS ATHENS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BOYETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-233-2332
Mailing Address - Street 1:1860 US HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-5062
Mailing Address - Country:US
Mailing Address - Phone:205-487-1111
Mailing Address - Fax:205-487-1114
Practice Address - Street 1:42030 HIGHWAY 195
Practice Address - Street 2:SUITE A
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-7054
Practice Address - Country:US
Practice Address - Phone:205-485-7248
Practice Address - Fax:205-485-7249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty