Provider Demographics
NPI:1669407862
Name:ORTHOPAEDIC & SPORTS INJURY CENTER
Entity type:Organization
Organization Name:ORTHOPAEDIC & SPORTS INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-227-4600
Mailing Address - Street 1:717 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4818
Mailing Address - Country:US
Mailing Address - Phone:770-227-4600
Mailing Address - Fax:770-227-9055
Practice Address - Street 1:717 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4818
Practice Address - Country:US
Practice Address - Phone:770-227-4600
Practice Address - Fax:770-227-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056944207X00000X
GA022788207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0437880002Medicare NSC
GAF01985Medicare UPIN
GAE19966Medicare UPIN