# ORTHO SPORT AND SPINE PHYSICIANS JACKSON

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891459616
- **Authorized official:** FAITH A BELTZHOOVER (REVENUE CYCLE MANAGEMENT DIRECTOR)
- **Authorized official phone:** (678) 752-7246

## Contact information

- **Practice address:** 4316 OLD CANTON RD, JACKSON, MS 39211-5995
- **Practice address phone:** (678) 752-7246
- **Mailing address:** 5788 ROSWELL RD STE 100, ATLANTA, GA 30328-4904
- **Mailing address phone:** (678) 752-7246

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/27/2021
- **Last updated:** 10/27/2021