Organization
PERFORMANCE ORTHOPAEDICS & SPORTS MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANELLE WATSON (PRACTICE MANAGER)
(404) 973-2444
Entity
Organization
Contact information
Practice address
755 MOUNT VERNON HWY NE STE 305, ATLANTA, GA 30328-4274
(404) 973-2444
(404) 935-9832
Mailing address
1266 W PACES FERRY RD NW STE 286, ATLANTA, GA 30327-2306
(404) 973-2444
(404) 935-9832
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
048913
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000867787I
—
GA
05
—
003113208A
—
GA
Enumeration date
08/23/2018
Last updated
08/23/2018
Update your record
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