Organization
MOUNTAINSIDE ORTHOPEDICS
Active
Organization
MOUNTAINSIDE ORTHOPEDICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER TARDIF (CREDENTIALING MANAGER)
(770) 801-2526
Entity
Organization
Contact information
Practice address
620 J L WHITE DR, SUITE 100, JASPER, GA 30143-4896
(706) 692-6980
Mailing address
PO BOX 102321, ATLANTA, GA 30368-2321
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
035504
GA
Other
Enumeration date
03/19/2007
Last updated
01/08/2009
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