MEDICARE: DR. JASON SCOTT ANDERSEN MD

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	207X00000X	Orthopaedic Surgery Physician	83924	SC
2	207X00000X	Orthopaedic Surgery Physician	077927	GA

General Provider Information

NPI Number	:	1992096903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON SCOTT ANDERSEN MD

Provider Business Mailing Address
First Line	:	148 BILL CARRUTH PKWY STE 120
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-3756
Country	:	US
Telephone Number	:	943-202-7010
Fax Number	:	470-986-7005

Provider Business Practice Location Address
First Line	:	148 BILL CARRUTH PKWY STE 120
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-3756
Country	:	US
Telephone Number	:	943-202-7010
Fax Number	:	470-986-7005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2011
Last Update Date	:	11/14/2022

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