Provider Demographics
NPI:1942477765
Name:ATLANTA ORTHOPEDIC & ARTHROSCOPY CENTER, P. C.
Entity Type:Organization
Organization Name:ATLANTA ORTHOPEDIC & ARTHROSCOPY CENTER, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FEROZE
Authorized Official - Middle Name:A
Authorized Official - Last Name:YUSUFJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-991-1150
Mailing Address - Street 1:6525 PROFESSIONAL PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2519
Mailing Address - Country:US
Mailing Address - Phone:770-991-1150
Mailing Address - Fax:770-991-1155
Practice Address - Street 1:6525 PROFESSIONAL PL
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2519
Practice Address - Country:US
Practice Address - Phone:770-991-1150
Practice Address - Fax:770-991-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014728174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00094685BMedicaid
GA00094685BMedicaid
GAD31707Medicare UPIN