Healthcare Provider Details

I. General information

NPI: 1699929703
Provider Name (Legal Business Name): PREMIER ORTHOPAEDICS AND SPORTS MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 WOODS COVE RD SUITE A
SCOTTSBORO AL
35768-2428
US

IV. Provider business mailing address

90 FAIRFAX LN
RINGGOLD GA
30736-1669
US

V. Phone/Fax

Practice location:
  • Phone: 256-574-2663
  • Fax: 256-574-2664
Mailing address:
  • Phone: 256-574-2663
  • Fax: 855-823-7569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD29131
License Number StateAL

VIII. Authorized Official

Name: MASOUD HAMIDIAN
Title or Position: MEMBER
Credential: MD
Phone: 256-574-2663