GEORGIA SPORTS MEDICINE, LLC (NPI# 1710160601) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710160601 |
| Entity Type | Organization |
| Organization Name | GEORGIA SPORTS MEDICINE, LLC |
| Practice Address |
6340 Sugarloaf Pkwy Ste 375 Duluth GA 30097-4333 |
| Practice Telephone | 7708142223 |
| Practice Fax Number | 7708142232 |
| Mailing Telephone | 7708142223 |
| Mailing Fax Number | 7708142232 |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2011-10-07 |
| Authorized Official Name | DR. MARK CULLEN (PROPIETOR) |
| Authorized Official Telephone | 7708142223 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
043191 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | MEDICARE GROUP ID | GRP5069 | 01 |
| Street Address |
6340 SUGARLOAF PKWY STE 375 |
| City | DULUTH |
| State | GA |
| Zip Code | 30097-4333 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760558290 | Quincy Love Warner | Psychologist | 6340 Sugarloaf Pkwy, Ste. 200, Duluth, GA 30097-4333 | 2006-11-27 |
| 1568929867 | Chintan Patel | Physical Therapist | 6340 Sugarloaf Pkwy, Duluth, GA 30097-4333 | 2019-02-23 |
| 1346797487 | Yinghua Zhang | Physical Therapist | 6340 Sugarloaf Pkwy, Duluth, GA 30097-4333 | 2016-09-07 |
| 1063643492 | Elizabeth Toomer | Physical Therapist | 6340 Sugarloaf Pkwy, Suite 125, Duluth, GA 30097-4333 | 2009-08-03 |
| 1215100185 | Schertell Family Enterprises Inc. | Home Health | 6340 Sugarloaf Pkwy, Duluth, GA 30097-4333 | 2008-04-10 |
| 1679751903 | Insured Health Care Company | Health Maintenance Organization | 6340 Sugarloaf Pkwy, Suite 200, Duluth, GA 30097-4333 | 2008-02-08 |
| 1235324252 | Atlanta Family Psychiatry, Inc | Counselor | 6340 Sugarloaf Pkwy, Suite 200, Duluth, GA 30097-4333 | 2007-09-12 |
| 1356470462 | Anne Remondi Imhoff | Psychologist | 6340 Sugarloaf Pkwy, Suite 200, Duluth, GA 30097-4333 | 2007-03-05 |
| 1023158334 | James Patrick Ware | Psychiatry & Neurology | 6340 Sugarloaf Pkwy, Suite 200, Duluth, GA 30097-4333 | 2007-02-07 |
| 1104964568 | Jennifer Elaine Bradberry | Specialist | 6340 Sugarloaf Pkwy, Suite 375, Duluth, GA 30097-4333 | 2007-02-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659986057 | Herman Medical Solutions, LLC | Internal Medicine | 10700 Medlock Bridge Road, Suite 207, Duluth, GA 30097 | 2020-09-11 |
| 1649808619 | Kirsty Amber Ramirez | Behavior Technician | 218 Premiere Pkwy #500, Duluth, GA 30097 | 2020-03-27 |
| 1386277820 | Cristina Madalina Niculas | Pharmacist | Kroger Pharmacy 476, 6555 Sugarloaf Parkway, Duluth, GA 30097 | 2020-02-12 |
| 1619514924 | Opesdei Health Solutions | Home Health Aide | 6615 Abbotts Bridge Road, 6615 Abbotts Bridge Road Unit 1111, Johns Creek, GA 30097 | 2019-12-05 |
| 1700422979 | Ria Alexander | Nurse Practitioner | 6300 Hospital Parkway Ste 300, Johns Creek, GA 30097 | 2019-11-22 |
| 1043867765 | Mosesal Zakia White | Nurse Practitioner | 10680 Medlock Bridge Rd #102, Johns Creek, GA 30097 | 2019-08-19 |
| 1982187068 | Lighthouse Clinical Counseling, LLC | Counselor | 3883 Rogers Bridge Road, Suite 601, Duluth, GA 30097 | 2018-09-13 |
| 1376025643 | Faithe Beanne Kimsey | Counselor | 3883 Rogers Bridge Road Nw, Suite 601, Duluth, GA 30097 | 2018-09-04 |
| 1306330303 | Denise Jackson | Prosthetist | 11720 Medlock Bridge Rd Ste 155, Johns Creek, GA 30097 | 2018-06-21 |
| 1407363328 | Berkeley Van Dyke | Physical Therapist | 6335 Hospital Pkwy Ste 316, Johns Creek, GA 30097 | 2017-12-30 |
| Find all providers in zip 30097 | ||||
| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346413648 | Mathew William Pombo | Orthopaedic Surgery | 3855 Pleasant Hill Rd Ste 470, Duluth, GA 30096-1417 | 2008-04-08 |
| 1659360568 | William Moten Craven | Orthopaedic Surgery | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2005-10-14 |
| 1447397799 | Samuel Harms | Orthopaedic Surgery | 1000 E 1st St, Suite 404, Duluth, MN 55805-2297 | 2007-01-30 |
| 1417028507 | Timothy Scott Maughon | Orthopaedic Surgery | 3855 Pleasant Hill Rd, Suite 470, Duluth, GA 30096-1407 | 2006-11-13 |
| 1710071931 | Gwinnett Sports Medicine & Orthopaedic Surgery PC | Orthopaedic Surgery | 10680 Medlock Bridge Road, Ste 102, Duluth, GA 30097 | 2006-10-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326679671 | Barbour Orthopaedics & Sports Medicine PC | Orthopaedic Surgery | 965 Oakland Rd Ste C, Lawrenceville, GA 30044-3758 | 2020-01-27 |
| 1932730298 | Barbour Orthopaedics & Sports Medicine PC | Orthopaedic Surgery | 1100 Northside Forsyth Dr Ste 360, Cumming, GA 30041-6022 | 2020-01-27 |
| 1275094310 | Mariolino Da Graca Fernandes | Orthopaedic Surgery | 3240 Northeast Expy Ne, Atlanta, GA 30341-4003 | 2019-03-29 |
| 1437601598 | Optim Orthopedics LLC | Orthopaedic Surgery | 460 Mall Blvd Ste B, Savannah, GA 31406-4801 | 2016-10-25 |
| 1750753182 | Zachary Russell | Orthopaedic Surgery | 1305 Jennings Mill Road, Building 300, Suite 110, Watkinsville, GA 30677 | 2015-10-26 |
| 1396121315 | 2 Bare Bones Medical LLC | Orthopaedic Surgery | 11102 Abercorn St, Savannah, GA 31419-1822 | 2015-07-31 |
| 1578985180 | Brandon Dobo | Orthopaedic Surgery | 410 Brookhaven Way Ne, Atlanta, GA 30319-3177 | 2014-01-16 |
| 1306102785 | Elan J Golan | Orthopaedic Surgery | 1800 Tree Ln Ste 140, Snellville, GA 30078-6799 | 2012-04-10 |
| 1235405747 | Pinnacle Orthopaedics & Sports Medicine Specia | Orthopaedic Surgery | 1000 Chastain Road, Building II, Kennesaw, GA 30144-0000 | 2012-03-29 |
| 1053466615 | Georgia Sports Orthopedic Specialists | Orthopaedic Surgery | 1466 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3852 | 2007-01-24 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.