Provider Demographics
NPI:1154546786
Name:MIDDLE GA ORTHOPEADIC
Entity type:Organization
Organization Name:MIDDLE GA ORTHOPEADIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FUNCTIONAL CAPACITY EVALUATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THARPE
Authorized Official - Suffix:
Authorized Official - Credentials:COTA, CEAS, CFCE
Authorized Official - Phone:478-953-7556
Mailing Address - Street 1:3370 ROSA CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-6737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3051 WATSON BLVD STE 400
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8556
Practice Address - Country:US
Practice Address - Phone:478-953-7556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000450261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy