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Organization
ORTHO SPORT AND SPINE PHYSICIANS CONYERS
Active
Organization
ORTHO SPORT AND SPINE PHYSICIANS CONYERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RA'KESHIA BROGDON (CREDENTIALING SPECIALIST)
(404) 941-1233
Entity
Organization
Contact information
Practice address
1292 WELLBROOK CIR NE, CONYERS, GA 30012-8031
(678) 831-7669
Mailing address
5788 ROSWELL RD, ATLANTA, GA 30328-4904
(305) 290-2448
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
01/15/2021
Last updated
01/03/2022
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