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General NPI Number Information
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NPI Number | 1699929703
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Entity Type | Organization
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Legal Business Name | PREMIER ORTHOPAEDICS AND SPORTS MEDICINE, LLC
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Dates
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Enumeration Date | 11/17/2008
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 380 WOODS COVE RD SUITE A
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City | SCOTTSBORO
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State | AL
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Zip | 35768-2428
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Country | US
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Telephone | 256-574-2663
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Fax | 256-574-2664
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Provider Business Mailing Address
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Address Line | 90 FAIRFAX LN
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City | RINGGOLD
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State | GA
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Zip | 30736-1669
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Country | US
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Telephone | 256-574-2663
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Fax | 855-823-7569
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Authorized Official
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Title or Position | MEMBER
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Name | MASOUD HAMIDIAN
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Credential | MD
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Telephone | 256-574-2663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | MD29131
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License Number State | AL
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