Provider Demographics
NPI:1871398602
Name:ORTHOCARE GEORGIA LLC
Entity type:Organization
Organization Name:ORTHOCARE GEORGIA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:N
Authorized Official - Last Name:GHATTAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-574-4619
Mailing Address - Street 1:33 UPPER RIVERDALE RD SW STE 121
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2642
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 UPPER RIVERDALE RD SW STE 121
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2642
Practice Address - Country:US
Practice Address - Phone:404-323-4096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty