Provider Demographics
NPI:1902864754
Name:THOMASVILLE ORTHOPEDIC CENTER, PC
Entity Type:Organization
Organization Name:THOMASVILLE ORTHOPEDIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:NUSBICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-226-9144
Mailing Address - Street 1:PO BOX 2968
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-2968
Mailing Address - Country:US
Mailing Address - Phone:229-226-9141
Mailing Address - Fax:229-228-0637
Practice Address - Street 1:100 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792
Practice Address - Country:US
Practice Address - Phone:229-226-9141
Practice Address - Fax:229-228-0637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACB2303OtherRAIL ROAD MEDICARE
GA0832790001OtherDMERC
GA0832790001OtherDMERC