Provider Demographics
NPI:1710029137
Name:CHATHAM ORTHOPAEDIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:CHATHAM ORTHOPAEDIC ASSOCIATES, PA
Other - Org Name:CHATHAM SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ADMIN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-525-1281
Mailing Address - Street 1:4425A PAULSEN STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3637
Mailing Address - Country:US
Mailing Address - Phone:912-354-5100
Mailing Address - Fax:912-354-5300
Practice Address - Street 1:4425A PAULSEN STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3637
Practice Address - Country:US
Practice Address - Phone:912-354-5100
Practice Address - Fax:912-354-5300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHATHAM ORTHOPAEDIC ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-13
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4954440001Medicare NSC