# OSSP IMAGING OF ST. LOUIS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ORTHO SPORT AND SPINE PHYSICIANS DAWSONVILLE
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1417534918
- **Legal business name:** ORTHO SPORT AND SPINE PHYSICIANS DAWSONVILLE
- **Authorized official:** RA'KESHIA BROGDON (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (404) 941-1233

## Contact information

- **Practice address:** 12401 OLIVE BLVD, SAINT LOUIS, MO 63141-5443
- **Practice address phone:** (314) 390-0135
- **Mailing address:** 5788 ROSWELL RD, ATLANTA, GA 30328-4904
- **Mailing address phone:** (305) 290-2448

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/29/2021
- **Last updated:** 03/29/2021