| Joint Regeneration & Anti-aging Of | |
|
1601 Georgian Park Ste Terrace Peachtree City GA 30269-6968 | |
| (770) 683-4495 | |
| Not Available |
| Full Name | Joint Regeneration & Anti-aging Of |
|---|---|
| Speciality | Clinic/Center |
| Location | 1601 Georgian Park Ste Terrace, Peachtree City, Georgia |
| Authorized Official Name and Position | Kristyn Manzi (OWNER) |
| Authorized Official Contact | 7706834495 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Joint Regeneration & Anti-aging Of 1601 Georgian Park Ste Terrace Peachtree City GA 30269-6968 Ph: () - | Joint Regeneration & Anti-aging Of 1601 Georgian Park Ste Terrace Peachtree City GA 30269-6968 Ph: (770) 683-4495 |
| NPI Number | 1073116554 |
|---|---|
| Provider Enumeration Date | 11/18/2020 |
| Last Update Date | 11/23/2020 |
| Medicare PECOS PAC ID | 8527479021 |
|---|---|
| Medicare Enrollment ID | O20201203002328 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073116554 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 261QM2500X | Clinic/center - Medical Specialty | (* (Not Available)) | Secondary |
| Provider Name | Cornell Peters |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861487225 PECOS PAC ID: 1557492758 Enrollment ID: I20100702000437 |
| Provider Name | Daniela S Ezratty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902183726 PECOS PAC ID: 2163680646 Enrollment ID: I20120301000407 |
| Provider Name | Barbara Haskew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467745422 PECOS PAC ID: 7719204932 Enrollment ID: I20150327002126 |
| Provider Name | William Elmore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164824132 PECOS PAC ID: 5092146159 Enrollment ID: I20200506000889 |
| Provider Name | Susannah Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942740360 PECOS PAC ID: 8426334699 Enrollment ID: I20210901000385 |
| Provider Name | Sharon Lisa Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720587413 PECOS PAC ID: 7315324738 Enrollment ID: I20220524001288 |
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