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Organization
ORTHO SPORT & SPINE PHYSICIANS
Active
Organization
ORTHO SPORT & SPINE PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RA'KESHIA BROGDON (CREDENTIALING SPECIALIST)
(404) 941-1233
Entity
Organization
Contact information
Practice address
2310 HENRY CLOWER BLVD STE 100A, SNELLVILLE, GA 30078-5776
(678) 752-7246
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
03/31/2021
Last updated
03/31/2021
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