Provider Demographics
NPI:1912019308
Name:ORTHOPAEDIC SPECIALISTS OF SOUTH GEORGIA
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPECIALISTS OF SOUTH GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-287-1130
Mailing Address - Street 1:PO BOX 2267
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-2267
Mailing Address - Country:US
Mailing Address - Phone:912-287-1130
Mailing Address - Fax:912-287-1231
Practice Address - Street 1:501 W ONEIDA ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5337
Practice Address - Country:US
Practice Address - Phone:912-287-1130
Practice Address - Fax:912-287-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
GA4309190001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACH5524OtherPALMETTO GBA
GAGRP3810Medicare ID - Type Unspecified
GACH5524OtherPALMETTO GBA