Organization
FOUR RIVERS ORTHOPEDIC ASSOC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS M ALLEN MD (AUTHORIZED OFFICIAL)
(912) 537-1815
Entity
Organization
Contact information
Practice address
500A MAPLE DR, VIDALIA, GA 30474-8998
(912) 537-1815
(912) 537-9557
Mailing address
500A MAPLE DR, VIDALIA, GA 30474-8998
(912) 537-1815
(912) 537-9557
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
GA053327
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
205709
BCBS
GA
Enumeration date
09/22/2005
Last updated
08/22/2020
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