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 STE 100, JASPER, GA 30143-4897
(706) 692-6980
Mailing address
620 J L WHITE DR STE 100, JASPER, GA 30143-4897
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
035504
GA
Other
Enumeration date
10/18/2006
Last updated
08/22/2020
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