Provider Demographics
NPI:1962629360
Name:SUTTON ORTHOPAEDICS & SPORTS MEDICINE, P.C.
Entity Type:Organization
Organization Name:SUTTON ORTHOPAEDICS & SPORTS MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:770-389-8386
Mailing Address - Street 1:145 MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5083
Mailing Address - Country:US
Mailing Address - Phone:770-389-8386
Mailing Address - Fax:770-507-9576
Practice Address - Street 1:500 W LANIER AVE
Practice Address - Street 2:SUITE 506
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7636
Practice Address - Country:US
Practice Address - Phone:770-389-8386
Practice Address - Fax:770-507-9576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0522210002Medicare NSC