Provider Demographics
NPI:1992959118
Name:CAPITAL CITY ORTHOPAEDICS & SPORTS MEDICINE, P.C.
Entity type:Organization
Organization Name:CAPITAL CITY ORTHOPAEDICS & SPORTS MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAID
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-303-8665
Mailing Address - Street 1:5555 PEACHTREE DUNWOODY ROAD NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1710
Mailing Address - Country:US
Mailing Address - Phone:404-303-8665
Mailing Address - Fax:404-303-8482
Practice Address - Street 1:5555 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 101
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1703
Practice Address - Country:US
Practice Address - Phone:404-303-8665
Practice Address - Fax:404-303-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA028403261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty