Organization
ORTHO SPORT AND SPINE PHYSICIANS LAS VEGAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RA'KESHIA BROGDON (CREDENTIALING SPECIALIST)
(404) 941-1233
Entity
Organization
Contact information
Practice address
2625 WIGWAM PKWY STE 102, HENDERSON, NV 89074-7326
(678) 752-7246
(770) 234-5326
Mailing address
5788 ROSWELL RD, ATLANTA, GA 30328-4904
(305) 290-2448
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
05/03/2021
Last updated
06/01/2023
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