Provider Demographics
NPI:1295709178
Name:ALBANY BONE & JOINT CLINIC PC
Entity type:Organization
Organization Name:ALBANY BONE & JOINT CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYLES
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:229-883-4707
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31702-0407
Mailing Address - Country:US
Mailing Address - Phone:229-883-4707
Mailing Address - Fax:229-435-1038
Practice Address - Street 1:619 POINTE NORTH BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-1514
Practice Address - Country:US
Practice Address - Phone:229-883-4707
Practice Address - Fax:229-435-1038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300034541AMedicaid
GA300034541AMedicaid
GAGRP3439Medicare ID - Type UnspecifiedGROUP #