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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
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