Provider Demographics
NPI:1144107038
Name:ORTHOXPRESS OF GEORGIA
Entity type:Organization
Organization Name:ORTHOXPRESS OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-534-2227
Mailing Address - Street 1:206 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3115
Mailing Address - Country:US
Mailing Address - Phone:662-534-2298
Mailing Address - Fax:662-404-7028
Practice Address - Street 1:2550 SANDY PLAINS RD STE 125
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7221
Practice Address - Country:US
Practice Address - Phone:770-824-9421
Practice Address - Fax:770-824-9422
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOXPRESS OF GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty