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EASTSIDE ORTHOCARE LLC NPI 1447398086


NPI Information

NPI: 1447398086
Provider Name: EASTSIDE ORTHOCARE LLC
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 11D2041554

Address:
2820 MAIN ST W
SNELLVILLE, GA
ZIP 30078
Phone: (770) 978-1422
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EASTSIDE ORTHOCARE LLC is a specialist in Snellville, GA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. EASTSIDE ORTHOCARE LLC NPI is 1447398086. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2820 MAIN ST W
SNELLVILLE, GA
ZIP 30078-156
Phone: (770) 978-1422
Fax: (770) 978-1423

The provider's authorized official is Craig M Mines .
The authorized official title is Owner President and has the following contact phone number (770) 978-1422.

The CLIA number assigned to this NPI record is 11D2041554 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/4/2007 and was last updated on 6/21/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistGEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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