Provider Demographics
NPI:1891145561
Name:PARAGON SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:PARAGON SPORTS MEDICINE LLC
Other - Org Name:PARAGON SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARDS
Authorized Official - Last Name:GARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-270-8978
Mailing Address - Street 1:3280 HOWELL MILL RD NW
Mailing Address - Street 2:STE 250
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4111
Mailing Address - Country:US
Mailing Address - Phone:470-270-8978
Mailing Address - Fax:470-355-7133
Practice Address - Street 1:3280 HOWELL MILL RD NW
Practice Address - Street 2:STE 250
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4111
Practice Address - Country:US
Practice Address - Phone:470-270-8978
Practice Address - Fax:470-355-7133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA56449207QS0010X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA056449OtherLICENSE
GABG8650031OtherDEA