# ORTHO SPORT AND SPINE PHYSICIANS CONYERS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578152351
- **Authorized official:** RA'KESHIA BROGDON (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (404) 941-1233

## Contact information

- **Practice address:** 1292 WELLBROOK CIR NE, CONYERS, GA 30012-8031
- **Practice address phone:** (678) 831-7669
- **Mailing address:** 5788 ROSWELL RD, ATLANTA, GA 30328-4904
- **Mailing address phone:** (305) 290-2448

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/15/2021
- **Last updated:** 01/03/2022