Provider Demographics
NPI:1689661787
Name:MINTER, JON E (DO)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:E
Last Name:MINTER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3400 OLD MILTON PKWY # C
Mailing Address - Street 2:STE 290
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3707
Mailing Address - Country:US
Mailing Address - Phone:770-667-4337
Mailing Address - Fax:770-677-4338
Practice Address - Street 1:3400 OLD MILTON PKWY # C
Practice Address - Street 2:STE 290
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-667-4337
Practice Address - Fax:770-677-4338
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2017-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA044545207X00000X, 207XS0114X
TNDO01978207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000761428LMedicaid
TN1507427Medicaid
VA1689661787Medicaid
GA000761428NMedicaid
GA000761428MMedicaid
GA000761428FMedicaid
VA1689661787Medicaid
TN103I086169Medicare UPIN
GA000761428LMedicaid
GA000761428FMedicaid
GA000761428MMedicaid
GAE75384Medicare UPIN