Organization
ORTHO SPORT & SPINE PHYSICIANS KENNESAW
Active
Organization
ORTHO SPORT & SPINE PHYSICIANS KENNESAW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER W SIMS (CREDENTIALING MANAGER)
(678) 752-7246
Entity
Organization
Contact information
Practice address
3900 FREY RD NW STE 106, KENNESAW, GA 30144-5424
(678) 752-7246
Mailing address
5788 ROSWELL RD, ATLANTA, GA 30328-4904
(678) 752-7246
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
261QP3300X
Pain Clinic/Center
—
—
Other
Enumeration date
06/04/2020
Last updated
06/22/2023
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