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General NPI Number Information
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NPI Number | 1831670322
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Entity Type | Organization
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Legal Business Name | PERFORMANCE ORTHOPAEDICS & SPORTS MEDICINE
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 755 MOUNT VERNON HWY NE STE 305
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City | ATLANTA
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State | GA
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Zip | 30328-4274
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Country | US
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Telephone | 404-973-2444
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Fax | 404-935-9832
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Provider Business Mailing Address
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Address Line | 1266 W PACES FERRY RD NW STE 286
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City | ATLANTA
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State | GA
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Zip | 30327-2306
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Country | US
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Telephone | 404-973-2444
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Fax | 404-935-9832
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | JANELLE WATSON
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Credential |
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Telephone | 404-973-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 048913
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License Number State | GA
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