Provider Demographics
NPI:1669486981
Name:SOUTH METRO BONE & JOINT PC
Entity Type:Organization
Organization Name:SOUTH METRO BONE & JOINT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:FINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-507-5000
Mailing Address - Street 1:175 COUNTRY CLUB DR
Mailing Address - Street 2:BLDG 100 SUITE E
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9054
Mailing Address - Country:US
Mailing Address - Phone:770-507-5000
Mailing Address - Fax:770-507-5075
Practice Address - Street 1:175 COUNTRY CLUB DR
Practice Address - Street 2:BLDG 100 SUITE E
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9054
Practice Address - Country:US
Practice Address - Phone:770-507-5000
Practice Address - Fax:770-507-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADA4970Medicare PIN
GAGRP6186Medicare PIN