Organization
SPORTS MEDICINE ASSOCIATES OF AUGUSTA, LLC
Active
Other names
Champion Orthopedics
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA A. KINNEY P.T. (ADMINISTRATOR)
(706) 210-7529
Entity
Organization
Contact information
Practice address
1706 MAGNOLIA WAY, AUGUSTA, GA 30909-9481
(706) 210-7529
(706) 312-7610
Mailing address
1706 MAGNOLIA WAY, AUGUSTA, GA 30909-9481
(706) 210-7529
(706) 312-7610
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300034841A
—
GA
05
—
30003484LA
—
GA
01
—
CJ3550
RAILROAD MEDICARE
SC
05
—
GPA745
—
SC
Enumeration date
02/08/2007
Last updated
02/07/2015
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