=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841527819
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNTAIN MEDICAL SPECILITIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2009
-----------------------------------------------------
Last Update Date | 05/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 156 N MAIN ST
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30525-4266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-782-4799
-----------------------------------------------------
Fax | 706-782-0922
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 156 N MAIN ST
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30525-4266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-782-4799
-----------------------------------------------------
Fax | 706-782-0922
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD DIRECTOR
-----------------------------------------------------
Name | DR. ARTHUR B FLICK
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 706-782-4799
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------