Organization
DOMINION ORTHOPAEDIC CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN I FOSTER III MD (PRESIDENT)
(770) 455-4009
Entity
Organization
Contact information
Practice address
4235 JOHNS CREEK PKWY, SUITE B, SUWANEE, GA 30024-6038
(770) 455-4009
(770) 455-4065
Mailing address
5555 PEACHTREE DUNWOODY RD NE, SUITE 215, ATLANTA, GA 30342-1703
(770) 455-4009
(770) 455-4065
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP7986
MEDICARE PTAN
GA
Enumeration date
09/08/2009
Last updated
09/08/2009
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