| Regenerative Joint Clinics Llc | |
|
483 Upper Riverdale Rd Sw Ste F Riverdale GA 30274-2579 | |
| (706) 248-8456 | |
| Not Available |
| Full Name | Regenerative Joint Clinics Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 483 Upper Riverdale Rd Sw Ste F, Riverdale, Georgia |
| Authorized Official Name and Position | Jack Wright (MANAGING MEMBER) |
| Authorized Official Contact | 7062488456 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Regenerative Joint Clinics Llc 1171 Laurel Pointe Watkinsville GA 30677-7559 Ph: (706) 248-8456 | Regenerative Joint Clinics Llc 483 Upper Riverdale Rd Sw Ste F Riverdale GA 30274-2579 Ph: (706) 248-8456 |
| NPI Number | 1548838485 |
|---|---|
| Provider Enumeration Date | 06/16/2021 |
| Last Update Date | 06/16/2022 |
| Medicare PECOS PAC ID | 8022410687 |
|---|---|
| Medicare Enrollment ID | O20210706002097 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548838485 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Peter Ping Lee |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1205828993 PECOS PAC ID: 4981507845 Enrollment ID: I20050106000374 |
| Provider Name | Barbara Haskew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467745422 PECOS PAC ID: 7719204932 Enrollment ID: I20150327002126 |
| Provider Name | Alicia Malinda Darby-bishop |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760092134 PECOS PAC ID: 4789088139 Enrollment ID: I20210806000221 |
| Provider Name | Michael Levern Carter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982876579 PECOS PAC ID: 9133513807 Enrollment ID: I20220222001922 |
| Provider Name | Christina Tyree Gary |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750951349 PECOS PAC ID: 3375915606 Enrollment ID: I20230214001194 |
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