MEDICARE: EASTSIDE ORTHOCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		GA

General Provider Information

NPI Number	:	1447398086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTSIDE ORTHOCARE LLC

Provider Business Mailing Address
First Line	:	2820 MAIN ST W
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-3156
Country	:	US
Telephone Number	:	770-978-1422
Fax Number	:	770-978-1423

Provider Business Practice Location Address
First Line	:	2820 MAIN ST W
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-3156
Country	:	US
Telephone Number	:	770-978-1422
Fax Number	:	770-978-1423

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	DR. CRAIG M MINES
Credential	:	M.D.
Telephone Number	:	770-978-1422

Provider Enumeration Date	:	02/04/2007
Last Update Date	:	06/21/2021

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Directions to “EASTSIDE ORTHOCARE LLC ” Practice Location

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