Provider Demographics
NPI:1689736100
Name:ATHENS BONE AND JOINT PC
Entity Type:Organization
Organization Name:ATHENS BONE AND JOINT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:DORRIS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:706-583-9000
Mailing Address - Street 1:1010 PRINCE AVE
Mailing Address - Street 2:SUITE 115 SOUTH
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5805
Mailing Address - Country:US
Mailing Address - Phone:706-583-9000
Mailing Address - Fax:706-353-6525
Practice Address - Street 1:1010 PRINCE AVE
Practice Address - Street 2:SUITE 115 SOUTH
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5805
Practice Address - Country:US
Practice Address - Phone:706-583-9000
Practice Address - Fax:706-353-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040899174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000805054BMedicaid
GA000805054BMedicaid
GA7554360001Medicare NSC
GAG57604Medicare UPIN