PROVIDENCE ORTHOPEDICS & SPORTS MEDICINE, PC (NPI# 1881895035) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881895035 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE ORTHOPEDICS & SPORTS MEDICINE, PC |
| Practice Address |
1401 W Spring St Suite 200 Monroe GA 30655-1760 |
| Practice Telephone | 7702670978 |
| Practice Fax Number | 7702077842 |
| Mailing Telephone | 7702670978 |
| Mailing Fax Number | 7702077842 |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2009-12-30 |
| Authorized Official Name | DR. DAVID C HARKINS I (PRESIDENT) |
| Authorized Official Telephone | 7702670978 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XS0114X |
Orthopaedic Surgery Specialization: Adult Reconstructive Orthopaedic Surgery |
055950 | GA | Allopathic & Osteopathic Physicians |
| Street Address |
1401 W SPRING ST SUITE 200 |
| City | MONROE |
| State | GA |
| Zip Code | 30655-1760 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558968149 | Coresa Hawanis Thomas | Counselor | Advantage Behavioral Health, 384 State Hwy 11 Sw, Walton, GA 30655 | 2020-10-06 |
| 1821629049 | Daniel A Hodges | Dentist | 1190 West Spring St, Suite A, Monroe, GA 30655 | 2020-01-27 |
| 1669019071 | Daniel Bradley Hodges | Dentist | 1190 W. Spring St, Monroe, GA 30655 | 2019-12-04 |
| 1861962730 | Danny Shoemake | Counselor | 2080 Highway 78 Nw, Monroe, GA 30655 | 2018-12-04 |
| 1205329687 | Advantage Behavioral Health Systems | Clinic/Center | 638 Michael Cir., Monroe, GA 30655 | 2018-06-11 |
| 1144722455 | Catherine Williams | Behavioral Analyst | 109 Blaine Street, Monroe, GA 30655 | 2018-03-02 |
| 1588186811 | Francette Dubuche Bernard | Nurse Practitioner | 398 Highway 11, Sw, Monroe, GA 30655 | 2017-07-07 |
| 1437699006 | Amanda Kaye Green | Nurse Practitioner | 517 Great Oaks Drive Suite 103, Monroe, GA 30655 | 2017-03-02 |
| 1639528524 | Matthew Bradford Allgood | Physical Therapist | 2120 W Spring St Ste 1500, Monroe, GA 30655 | 2016-06-10 |
| 1477939221 | Healthy Home Transitions | Social Worker | 506 S Broad Street, Monroe, GA 30655 | 2015-08-04 |
| Find all providers in zip 30655 | ||||
| Taxonomy Code | 207XS0114X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Adult Reconstructive Orthopaedic Surgery |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, adult reconstructive orthopaedic surgeons deal with reconstructive procedures such as joint arthroplasty (i.e., hip and knee), osteotomy, arthroscopy, soft-tissue reconstruction, and a variety of other adult reconstructive surgical procedures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407851355 | Donald R. Polakoff | Orthopaedic Surgery | 111 Union Valley Rd, Suite 102, Monroe, NJ 08831-6000 | 2005-06-16 |
| 1205061504 | Kevin Jeffrey Bunn | Orthopaedic Surgery | 920 Oliver Rd, Monroe, LA 71201 | 2009-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013327642 | Richard Allen Boe Jr. | Orthopaedic Surgery | 2041 Mesa Valley Way Ste 100, Austell, GA 30106-6856 | 2014-05-05 |
| 1205274800 | Fernando David Nussenbaum | Orthopaedic Surgery | 135 N Park Pl Ste 101, Stockbridge, GA 30281-7237 | 2013-06-05 |
| 1265701304 | Tattnall Hospital Company LLC | Orthopaedic Surgery | 459 Ga Highway 119 S, Springfield, GA 31329-3021 | 2011-12-19 |
| 1760627699 | Stattesboro Orthopaedic Center, Inc | Orthopaedic Surgery | 1497 Fair Rd, Ste 101, Statesboro, GA 30458-0823 | 2008-12-05 |
| 1851551535 | Jeffrey Peretz | Orthopaedic Surgery | 5671 Peachtree Dunwoody Rd Ne, Suite 700, Atlanta, GA 30342-5000 | 2008-06-16 |
| 1801950712 | Randall Miller Meredith | Orthopaedic Surgery | 811 13th St, Suite 20, Augusta, GA 30901-2700 | 2006-12-22 |
| 1407923089 | Dublin Multispecialty LLC | Orthopaedic Surgery | 100 Medical Dr, Suite 100 & 200, Dublin, GA 31021 | 2006-11-29 |
| 1518977701 | Timothy Richard Young | Orthopaedic Surgery | 1 Freedom Way, Vamc Orthopedics, Augusta, GA 30904-6258 | 2006-08-09 |
| 1720019698 | Thomas Lane Bradbury Jr. | Orthopaedic Surgery | 59 Executive Park S, Atlanta, GA 30329-2208 | 2006-07-06 |
| 1295761450 | Greg Erens | Orthopaedic Surgery | 59 Executive Park S, Suite 2000, Atlanta, GA 30329-2208 | 2006-06-22 |
| Find all providers with the same taxonomy | ||||
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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.