Provider Demographics
NPI:1386908184
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:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:CAO
Authorized Official - Phone:770-429-7741
Mailing Address - Street 1:300 TOWER ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-9403
Mailing Address - Country:US
Mailing Address - Phone:770-427-5717
Mailing Address - Fax:770-514-6744
Practice Address - Street 1:4550 COBB PARKWAY NW
Practice Address - Street 2:SUITE 309G
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-0000
Practice Address - Country:US
Practice Address - Phone:678-213-5717
Practice Address - Fax:678-213-5723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE ORTHOPAEDICS & SPORTS MEDICINE SPECIALISTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-27
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31591207X00000X
GA65285208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty