# ORTHO SPORT & SPINE PHYSICIANS COLUMBIA

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

## Provider details

- **NPI number:** 1952877615
- **Authorized official:** WHITNEY GLOVER (CREDENTIALING)
- **Authorized official phone:** (678) 783-7615

## Contact information

- **Practice address:** 11 ATRIUM RIDGE CT, COLUMBIA, SC 29223-6438
- **Practice address phone:** (678) 752-7246
- **Mailing address:** 5788 ROSWELL RD, ATLANTA, GA 30328-4904

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/22/2018
- **Last updated:** 02/16/2023