Healthcare Provider Details

I. General information

NPI: 1689661787
Provider Name (Legal Business Name): JON E. MINTER D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 OLD MILTON PKWY # C STE 290
ALPHARETTA GA
30005-3707
US

IV. Provider business mailing address

3400 OLD MILTON PKWY # C STE 290
ALPHARETTA GA
30005-3707
US

V. Phone/Fax

Practice location:
  • Phone: 770-667-4337
  • Fax: 770-677-4338
Mailing address:
  • Phone: 770-667-4337
  • Fax: 770-677-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number044545
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number044545
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDO01978
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: