1780819409 NPI number — O'BRIEN ORTHOPEDICS, INC.

Table of content: (NPI 1780819409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780819409 NPI number — O'BRIEN ORTHOPEDICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
O'BRIEN ORTHOPEDICS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
O'BRIEN ORTHOPEDICS, L.L.C..
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780819409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 HINES RD NE
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
CALHOUN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30701-9374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-624-9494
Provider Business Mailing Address Fax Number:
706-624-9191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 MEDICAL DR NE
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
CARTERSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30121-8005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-721-6800
Provider Business Practice Location Address Fax Number:
678-721-6803
Provider Enumeration Date:
05/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SORENSEN
Authorized Official First Name:
AARON
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER, PRESIDENT
Authorized Official Telephone Number:
615-542-0897

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  000011 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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