Provider Demographics
NPI:1316089121
Name:PINNACLE ORTHOPAEDICS & SPORTS MEDICINE SPECIALISTS LLC
Entity type:Organization
Organization Name:PINNACLE ORTHOPAEDICS & SPORTS MEDICINE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-427-5717
Mailing Address - Street 1:300 TOWER ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-9403
Mailing Address - Country:US
Mailing Address - Phone:770-218-0219
Mailing Address - Fax:770-218-9847
Practice Address - Street 1:1505 STONEBRIDGE PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-0000
Practice Address - Country:US
Practice Address - Phone:770-926-9112
Practice Address - Fax:770-926-8240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1258460007Medicare NSC