Provider Demographics
NPI:1447611132
Name:ORTHO MEDICAL MANAGEMENT LLC
Entity type:Organization
Organization Name:ORTHO MEDICAL MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:
Authorized Official - Last Name:COTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-613-0670
Mailing Address - Street 1:5050 JIMMY CARTER BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-2711
Mailing Address - Country:US
Mailing Address - Phone:770-613-0670
Mailing Address - Fax:770-559-1021
Practice Address - Street 1:5050 JIMMY CARTER BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2711
Practice Address - Country:US
Practice Address - Phone:770-613-0670
Practice Address - Fax:770-559-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10937577239Medicaid