Provider Demographics
NPI:1952076382
Name:AUGUSTA ORTHOPEDIC & SPORTS MEDICINE SPECIALISTS PC
Entity Type:Organization
Organization Name:AUGUSTA ORTHOPEDIC & SPORTS MEDICINE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLEGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-863-9797
Mailing Address - Street 1:PO BOX 14039
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30919-0039
Mailing Address - Country:US
Mailing Address - Phone:706-863-9797
Mailing Address - Fax:706-860-7686
Practice Address - Street 1:410 UNIVERSITY PKWY STE 1000
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6800
Practice Address - Country:US
Practice Address - Phone:803-644-4264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUGUSTA ORTHOPEDIC & SPORT MEDICINE SPECIALISTS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-09
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty