MEDICARE: PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0922510003	OTHER	TN	MEDICARE DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174600332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC

Provider Business Mailing Address
First Line	:	PO BOX 370
Second Line	:
City	:	FORTSON
State	:	GA
Zip	:	31808-0370
Country	:	US
Telephone Number	:	706-324-6661
Fax Number	:

Provider Business Practice Location Address
First Line	:	394 HARDING PL
Second Line	:	SUITE 200
City	:	NASHVILLE
State	:	TN
Zip	:	37211-3980
Country	:	US
Telephone Number	:	615-834-4482
Fax Number	:	615-834-4722

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	AMANDA GRACE FROMKIN
Credential	:
Telephone Number	:	706-494-3071

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/17/2023

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