Four Rivers Orthopedic Assoc PC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

GA053327 Issued in GA

Legal business name

FOUR RIVERS ORTHOPEDIC ASSOC PC

Practice address

500A Maple Dr
Vidalia, GA 30474-8998

Phone

(912) 537-1815

Fax

(912) 537-9557

NPI assigned

Sep 22, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Thomas M Allen, MD

Title

Authorized Official

Phone

(912) 537-1815

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831185172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500A MAPLE DR",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304748998",
            "telephone_number": "912-537-1815",
            "fax_number": "912-537-9557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500A MAPLE DR",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304748998",
            "telephone_number": "912-537-1815",
            "fax_number": "912-537-9557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR RIVERS ORTHOPEDIC ASSOC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "912-537-1815",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "GA",
            "license": "GA053327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "205709",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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.