# ORTHO SPORT AND SPINE PHYSICIANS DOUGLASVILLE

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1760082077
- **Authorized official:** FAITH A BELTZHOOVER (BILLING DIRECTOR)
- **Authorized official phone:** (678) 752-7246

## Contact information

- **Practice address:** 6043 PRESTLEY MILL RD, DOUGLASVILLE, GA 30134-2280
- **Practice address phone:** (678) 752-7246
- **Mailing address:** 5788 ROSWELL RD STE 100, ATLANTA, GA 30328-4904
- **Mailing address phone:** (678) 752-7246
- **Mailing address fax:** (770) 234-5326

## Taxonomy

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

## Other

- **Enumeration date:** 10/27/2020
- **Last updated:** 02/22/2021