1861029084 NPI number — PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC

Table of content: JORDAN N. NOBLE MD (NPI 1730768136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861029084 NPI number — PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861029084
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORTSON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31808-0370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
706-494-3008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2933 MEDICAL CENTER PKWY STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37129-2391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-342-6300
Provider Business Practice Location Address Fax Number:
615-342-6350
Provider Enumeration Date:
03/26/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FROMKIN
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MGR
Authorized Official Telephone Number:
706-494-3071

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)