NPIMap

Organization Active NPI

Orthoatlanta, LLC

  • Orthopaedic Surgery Physician
  • Brookhaven, GA
National Provider Identifier
1265047005
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ORTHOATLANTA, LLC
Practice address
3929 Peachtree Rd NE Ste 250
Brookhaven, GA 30319-3374
Phone
(404) 352-1053
Fax
(404) 350-0840
NPI assigned
Sep 9, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

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

Authorized official

Name
Teyanna Conyers
Title
Director of Credentialing
Phone
(678) 680-4945

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary
Orthopaedic Hand Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XS0106X
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0005X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

3929 Peachtree Rd NE Ste 250
Brookhaven, GA 30319-3374

Mailing address

900 Circle 75 Pkwy SE Ste 1700
Atlanta, GA 30339-3087
Phone (770) 953-6929

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040129000005 GA Part B Supplier - Clinic/Group Practice 3971406885 Receives reassigned benefits from 220 practitioners
24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lawrenceville, GA; Lithonia, GA; Locust Grove, GA; Macon, GA; Marietta, GA; McDonough, GA; Newnan, GA; Peachtree City, GA…
O20210226001118 GA DME Supplier - Physician - Orthopedic/Orthopedic Surgery 3971406885 Practice locations: Brookhaven, GA

Other NPIs with the same Medicare PAC ID 19

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 19

Other NPIs on the same Medicare enrollment 21

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 21

National Provider Directory

National Provider Directory
Tax ID family
Orthoatlanta LLC21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

3929 Peachtree Rd NE
Ste 250
Brookhaven, GA 30319
Phone (404) 352-1053

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1599609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742774400000",
    "number": "1265047005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 CIRCLE 75 PKWY SE STE 1700",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303393087",
            "telephone_number": "770-953-6929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3929 PEACHTREE RD NE STE 250",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303193374",
            "telephone_number": "404-352-1053",
            "fax_number": "404-350-0840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOATLANTA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-09",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A",
        "authorized_official_last_name": "CONYERS",
        "authorized_official_first_name": "TEYANNA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "678-680-4945"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookhaven, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.