Provider Demographics
NPI:1760875603
Name:FAMILY ORTHOPEDIS, PC
Entity Type:Organization
Organization Name:FAMILY ORTHOPEDIS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-335-9081
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-0009
Mailing Address - Country:US
Mailing Address - Phone:706-335-9081
Mailing Address - Fax:706-335-7194
Practice Address - Street 1:930 FRANKLIN SPRINGS ST
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-3908
Practice Address - Country:US
Practice Address - Phone:706-335-9081
Practice Address - Fax:706-335-7194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA23725207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000291772PMedicaid
GA202G206493Medicare PIN
GA20BDCFFMedicare UPIN