Provider Demographics
NPI:1659451078
Name:ACADEMY ORTHOPEDICS, LLC
Entity type:Organization
Organization Name:ACADEMY ORTHOPEDICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KALSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-889-0891
Mailing Address - Street 1:318 TRIBBLE GAP RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2440
Mailing Address - Country:US
Mailing Address - Phone:770-889-0893
Mailing Address - Fax:770-889-0354
Practice Address - Street 1:318 TRIBBLE GAP RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2440
Practice Address - Country:US
Practice Address - Phone:770-889-0893
Practice Address - Fax:770-889-0354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACADEMY ORTHOPEDICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-17
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058-218261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA058-218OtherDHR PERMIT
GA11189ASCAMedicare ID - Type UnspecifiedASC PROVIDER NUMBER