Basic Information
Provider Information
NPI: 1306038807
EntityType: 2
ReplacementNPI:  
OrganizationName: DUBLIN ORTHOPAEDICS & REHABILITATION, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2400 BELLEVUE RD STE 15
Address2: PO BOX 368
City: DUBLIN
State: GA
PostalCode: 310212894
CountryCode: US
TelephoneNumber: 4782723022
FaxNumber: 4782724233
Practice Location
Address1: 2400 BELLEVUE RD STE 15
Address2:  
City: DUBLIN
State: GA
PostalCode: 310212894
CountryCode: US
TelephoneNumber: 4782723022
FaxNumber: 4782724233
Other Information
ProviderEnumerationDate: 08/17/2007
LastUpdateDate: 05/29/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: PETERS
AuthorizedOfficialFirstName: JAMES
AuthorizedOfficialMiddleName: D
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 4782723022
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: D.O.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000X022866GAN193400000X MULTIPLE SINGLE SPECIALTY GROUPOther Service ProvidersSpecialist 
174400000X036595GAN193400000X MULTIPLE SINGLE SPECIALTY GROUPOther Service ProvidersSpecialist 
207X00000X036595GAY193400000X MULTIPLE SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic Surgery 

ID Information
IDTypeStateIssuerDescription
00539569A05GA MEDICAID
00249235C05GA MEDICAID


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