Provider Demographics
NPI:1700090008
Name:NORTHEAST GEORGIA INSTITUTE OF BONE & JOINT SURGERY
Entity Type:Organization
Organization Name:NORTHEAST GEORGIA INSTITUTE OF BONE & JOINT SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FORDYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-297-7877
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-1404
Mailing Address - Country:US
Mailing Address - Phone:706-297-7877
Mailing Address - Fax:706-297-7865
Practice Address - Street 1:3018 FALLS ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577
Practice Address - Country:US
Practice Address - Phone:706-297-7877
Practice Address - Fax:706-297-7865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4748Medicare ID - Type Unspecified