Provider Demographics
NPI:1396760260
Name:PIEDMONT SPORTS MEDICINE & ORTHOPAEDIC CLINIC, PC
Entity type:Organization
Organization Name:PIEDMONT SPORTS MEDICINE & ORTHOPAEDIC CLINIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-474-2114
Mailing Address - Street 1:1625 HARDEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1417
Mailing Address - Country:US
Mailing Address - Phone:478-474-2114
Mailing Address - Fax:478-474-8001
Practice Address - Street 1:1625 HARDEMAN AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1417
Practice Address - Country:US
Practice Address - Phone:478-474-2114
Practice Address - Fax:478-346-3635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026449207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0710330001Medicare NSC
GAGRP1017Medicare PIN