Provider Demographics
NPI:1205969516
Name:CENTER FOR ORTHOPAEDIC AND SPORTS MEDICINE
Entity type:Organization
Organization Name:CENTER FOR ORTHOPAEDIC AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-565-0011
Mailing Address - Street 1:1211 JOHNSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2722
Mailing Address - Country:US
Mailing Address - Phone:770-565-0011
Mailing Address - Fax:770-565-9866
Practice Address - Street 1:1211 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2722
Practice Address - Country:US
Practice Address - Phone:770-565-0011
Practice Address - Fax:770-565-9866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1971Medicare ID - Type UnspecifiedGROUP ID NUMBER
GA0509280001Medicare NSC