Provider Demographics
NPI:1447276811
Name:GEORGIA BONE & JOINT, LLC
Entity type:Organization
Organization Name:GEORGIA BONE & JOINT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:1755 HIGHWAY 34 E
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-5631
Mailing Address - Country:US
Mailing Address - Phone:770-502-2175
Mailing Address - Fax:770-502-2131
Practice Address - Street 1:1755 HIGHWAY 34 E
Practice Address - Street 2:SUITE 2200
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-5631
Practice Address - Country:US
Practice Address - Phone:770-502-2175
Practice Address - Fax:770-502-2131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20060002032207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6335070001Medicare NSC