Organization
ORTHOSPORTS1ST GA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRYAN WIMBISH (CCO)
(334) 701-6386
Entity
Organization
Contact information
Practice address
4300 BELLS FERRY RD NW, KENNESAW, GA 30144-1304
(470) 790-0725
(470) 754-0882
Mailing address
PO BOX 830525, DEPARTMENT# OWC 24, BIRMINGHAM, AL 35283-0525
(470) 790-0725
(470) 754-0882
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
Other
Enumeration date
02/19/2025
Last updated
03/21/2025
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