Provider Demographics
NPI:1124165964
Name:SUTTON ORTHOPAEDICS & SPORTS MEDICINE PC
Entity type:Organization
Organization Name:SUTTON ORTHOPAEDICS & SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:770-389-8386
Mailing Address - Street 1:145 MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5083
Mailing Address - Country:US
Mailing Address - Phone:770-389-8386
Mailing Address - Fax:770-507-9576
Practice Address - Street 1:500 W LANIER AVE
Practice Address - Street 2:SUITE 506
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7636
Practice Address - Country:US
Practice Address - Phone:770-389-8386
Practice Address - Fax:770-507-9576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2740Medicare PIN