# MIDWESTERN ADVANCED ORTHOPAEDICS AND SPORTS MEDICINE INC

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

## Provider details

- **NPI number:** 1740560978
- **Authorized official:** DOUGLAS TOUSSAINT JOHNSON PA-C (OWNER)
- **Authorized official phone:** (404) 296-5005

## Contact information

- **Practice address:** 2801 N DECATUR RD, SUITE 200, DECATUR, GA 30033-5949
- **Practice address phone:** (404) 296-5005
- **Practice address fax:** (404) 296-2070
- **Mailing address:** 433 HIGHLAND AVE NE, APT 1407, ATLANTA, GA 30312-1391
- **Mailing address phone:** (404) 296-5005
- **Mailing address fax:** (404) 296-2070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | 6115 | GA | Yes |

## Other

- **Enumeration date:** 08/19/2011
- **Last updated:** 08/19/2011