Provider Demographics
NPI:1447552096
Name:BLUE RIDGE ORTHOPEDICS INC.
Entity type:Organization
Organization Name:BLUE RIDGE ORTHOPEDICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:NUELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-439-6805
Mailing Address - Street 1:35 HOSPITAL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3139
Mailing Address - Country:US
Mailing Address - Phone:706-439-6805
Mailing Address - Fax:706-439-6806
Practice Address - Street 1:35 HOSPITAL RD STE 1
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3139
Practice Address - Country:US
Practice Address - Phone:706-439-6805
Practice Address - Fax:706-439-6806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA48284207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00852046AMedicaid
GA00852046AMedicaid