NPIMap

Organization Active NPI

Orthosports1St Ga

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Kennesaw, GA
National Provider Identifier
1326844689
Registry record updated Mar 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
ORTHOSPORTS1ST GA
Practice address
4300 Bells Ferry Rd NW
Kennesaw, GA 30144-1304
Phone
(470) 790-0725
Fax
(470) 754-0882
NPI assigned
Feb 19, 2025
Last updated
Mar 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2025

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

Authorized official

Name
Mr. Bryan WimbishNPI 1891203873
Title
Cco
Phone
(334) 701-6386

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X NU Primary

Addresses

Primary practice location

4300 Bells Ferry Rd NW
Kennesaw, GA 30144-1304

Mailing address

PO Box 830525
Department# Owc 24
Birmingham, AL 35283-0525
Phone (470) 790-0725

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250709000246 GA Part B Supplier - Clinic/Group Practice 8628582962 Receives reassigned benefits from 7 practitioners
Practice locations: Kennesaw, GA

National Provider Directory

National Provider Directory

Locations

4300 Bells Ferry Rd NW
Kennesaw, GA 30144
Phone (470) 790-0725

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1739923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742515200000",
    "number": "1326844689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 830525",
            "address_2": "DEPARTMENT# OWC 24",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352830525",
            "telephone_number": "470-790-0725",
            "fax_number": "470-754-0882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 BELLS FERRY RD NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301441304",
            "telephone_number": "470-790-0725",
            "fax_number": "470-754-0882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOSPORTS1ST GA",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-19",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-21",
        "status": "A",
        "authorized_official_last_name": "WIMBISH",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "CCO",
        "authorized_official_telephone_number": "334-701-6386",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "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 Mar 21, 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.