Organization
PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC
Active
Other names
Hughston Clinic Orthopaedics
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA GRACE FROMKIN (DIRECTOR OF CREDENTIALING)
(706) 494-3071
Entity
Organization
Contact information
Practice address
100 PHYSICIANS WAY, SUITE 120, LEBANON, TN 37090-8102
(615) 784-4336
(615) 784-4337
Mailing address
PO BOX 370, FORTSON, GA 31808-0370
(706) 324-6661
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0922510013
MEDICARE DME
TN
Enumeration date
12/03/2014
Last updated
10/24/2018
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