Provider Demographics
NPI:1912030982
Name:ATLANTA SPORTS MEDICINE & ORTHOPAEDIC CENTER
Entity Type:Organization
Organization Name:ATLANTA SPORTS MEDICINE & ORTHOPAEDIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATWATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-352-4500
Mailing Address - Street 1:3200 DOWNWOOD CIR NW
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1610
Mailing Address - Country:US
Mailing Address - Phone:404-352-4500
Mailing Address - Fax:404-352-9962
Practice Address - Street 1:3200 DOWNWOOD CIR NW
Practice Address - Street 2:SUITE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-1610
Practice Address - Country:US
Practice Address - Phone:404-352-4500
Practice Address - Fax:404-352-9962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Not Answered207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty