Provider Demographics
NPI:1447648977
Name:ORTHO SPORT & SPINE PHYSICIANS MORROW
Entity type:Organization
Organization Name:ORTHO SPORT & SPINE PHYSICIANS MORROW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVEUNE
Authorized Official - Prefix:
Authorized Official - First Name:JANESSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HASTINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-935-9116
Mailing Address - Street 1:5788 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6630 EXCHANGE PL
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2310
Practice Address - Country:US
Practice Address - Phone:678-752-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA63721207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty