Organization
SPORTS MEDICINE ASSOCIATES OF AUGUSTA, LLC
Active
Parent organization
SPORTS MEDICINE ASSOCIATES OF AUGUSTA, LLC
Other names
Champion Orthopedics
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPORTS MEDICINE ASSOCIATES OF AUGUSTA, LLC
Authorized official
MRS. PATRICIA A. KINNEY PT (ADMINISTRATOR)
(706) 210-7529
Entity
Organization
Contact information
Practice address
1706 MAGNOLIA WAY, AUGUSTA, GA 30909-9481
(706) 210-7529
(706) 312-7608
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
01
—
CJ3550
RAILROAD MEDICARE
SC
05
—
GPA745
—
SC
Enumeration date
05/14/2009
Last updated
04/03/2019
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