Basic Information
| Provider Information | |||||||||
| NPI: | 1689661787 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MINTER | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 OLD MILTON PKWY # C | ||||||||
| Address2: | STE 290 | ||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300053707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706674337 | ||||||||
| FaxNumber: | 7706774338 | ||||||||
| Practice Location | |||||||||
| Address1: | 3400 OLD MILTON PKWY # C | ||||||||
| Address2: | STE 290 | ||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300053707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706674337 | ||||||||
| FaxNumber: | 7706774338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 01/25/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 044545 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0114X | 044545 | GA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207X00000X | DO01978 | TN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 000761428L | 05 | GA | MEDICAID | 1507427 | 05 | TN | MEDICAID | 1689661787 | 05 | VA | MEDICAID | 000761428N | 05 | GA | MEDICAID | 000761428M | 05 | GA | MEDICAID | 000761428F | 05 | GA | MEDICAID |