Basic Information
| Provider Information | |||||||||
| NPI: | 1962458695 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAN, INC. | ||||||||
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| OtherOrganizationName: | MIDDLE GEORGIA ORTHOPAEDICS & SPORTS MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3340 PEACHTREE RD NE | ||||||||
| Address2: | STE 600 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303261000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042669876 | ||||||||
| FaxNumber: | 4042662669 | ||||||||
| Practice Location | |||||||||
| Address1: | 817 GRIFFIN AVE | ||||||||
| Address2: | |||||||||
| City: | EASTMAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310236718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783745766 | ||||||||
| FaxNumber: | 4783741285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4783745766 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 032261 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.