Provider Demographics
NPI:1700105996
Name:THE PEDIATRIC HAND & UPPER EXTREMITY CENTER OF GEORGIA, LLC
Entity Type:Organization
Organization Name:THE PEDIATRIC HAND & UPPER EXTREMITY CENTER OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRONIER
Authorized Official - Middle Name:L
Authorized Official - Last Name:COSTAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-255-0226
Mailing Address - Street 1:980 JOHNSON FERRY RD NE
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1626
Mailing Address - Country:US
Mailing Address - Phone:404-255-0226
Mailing Address - Fax:
Practice Address - Street 1:980 JOHNSON FERRY RD NE
Practice Address - Street 2:SUITE 1020
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1626
Practice Address - Country:US
Practice Address - Phone:404-255-0226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HAND & UPPER EXTREMITY CENTER OF GEORGIA, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty