Basic Information
| Provider Information | |||||||||
| NPI: | 1003879982 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GEORGIA BONE AND JOINT SURGEONS, P.C, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 MEDICAL DR NE STE 101 | ||||||||
| Address2: | |||||||||
| City: | CARTERSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301218005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703865221 | ||||||||
| FaxNumber: | 7703822591 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 MEDICAL DR NE STE 101 | ||||||||
| Address2: | |||||||||
| City: | CARTERSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301218005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703865221 | ||||||||
| FaxNumber: | 7703822591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | EDWARDS | ||||||||
| AuthorizedOfficialFirstName: | VICKIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7703865221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.