Provider Demographics
NPI:1447398086
Name:EASTSIDE ORTHOCARE LLC
Entity Type:Organization
Organization Name:EASTSIDE ORTHOCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:M
Authorized Official - Last Name:MINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-978-1422
Mailing Address - Street 1:2820 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3156
Mailing Address - Country:US
Mailing Address - Phone:770-978-1422
Mailing Address - Fax:770-978-1423
Practice Address - Street 1:2820 MAIN ST W
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3156
Practice Address - Country:US
Practice Address - Phone:770-978-1422
Practice Address - Fax:770-978-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-04
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty