NPIMap

Organization Active NPI

Ortho Sport & Spine Physicians Kennesaw

  • Physical Medicine & Rehabilitation Physician
  • Kennesaw, GA
National Provider Identifier
1164046132
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
ORTHO SPORT & SPINE PHYSICIANS KENNESAW
Practice address
3900 Frey Rd NW Ste 106
Kennesaw, GA 30144-5424
Phone
(678) 752-7246
NPI assigned
Jun 4, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christopher W Sims
Title
Credentialing Manager
Phone
(678) 752-7246

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary
Pain Clinic/Center 261QP3300X

Addresses

Primary practice location

3900 Frey Rd NW Ste 106
Kennesaw, GA 30144-5424

Mailing address

5788 Roswell Rd
Atlanta, GA 30328-4904
Phone (678) 752-7246

Other practice location 1

4255 Wade Green Rd NW
Kennesaw, GA 30144-1762
Phone (678) 752-7246

National Provider Directory

National Provider Directory
Tax ID family
Ortho Sport and Spine Physicians Pooler35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

Locations

4255 Wade Green Rd NW
Kennesaw, GA 30144
Phone (770) 843-9788

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687392000000",
    "number": "1164046132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5788 ROSWELL RD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303284904",
            "telephone_number": "678-752-7246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 FREY RD NW STE 106",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301445424",
            "telephone_number": "678-752-7246"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4255 Wade Green Rd NW",
            "address_purpose": "LOCATION",
            "city": "Kennesaw",
            "state": "GA",
            "postal_code": "301441762",
            "country_code": "US",
            "telephone_number": "678-752-7246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ORTHO SPORT & SPINE PHYSICIANS KENNESAW",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-04",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A",
        "authorized_official_last_name": "SIMS",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "678-752-7246"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennesaw, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.