NPIMap

Organization Active NPI

Northeast Georgia Orthopaedics & Sports Medicine, LLC

  • Orthopaedic Surgery Physician
  • Gainesville, GA
National Provider Identifier
1427079185
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
NORTHEAST GEORGIA ORTHOPAEDICS & SPORTS MEDICINE, LLC
Practice address
655 Jesse Jewell Pkwy SE
Suite B
Gainesville, GA 30501-3722
Phone
(770) 532-7092
Fax
(770) 536-0383
NPI assigned
Jul 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Donald Roger Willers, M.D.NPI 1154344737
Title
Member/Physician
Phone
(770) 532-7092

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
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

655 Jesse Jewell Pkwy SE
Suite B
Gainesville, GA 30501-3722

Mailing address

655 Jesse Jewell Pkwy SE
Suite B
Gainesville, GA 30501-3722
Phone (770) 532-7092

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1427079185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 JESSE JEWELL PKWY SE",
            "address_2": "SUITE B",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013722",
            "telephone_number": "770-532-7092",
            "fax_number": "770-536-0383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 JESSE JEWELL PKWY SE",
            "address_2": "SUITE B",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013722",
            "telephone_number": "770-532-7092",
            "fax_number": "770-536-0383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST GEORGIA ORTHOPAEDICS & SPORTS MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLERS",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "ROGER",
        "authorized_official_title_or_position": "MEMBER/PHYSICIAN",
        "authorized_official_telephone_number": "770-532-7092",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.