| Regenerative Medical Center, Pc | |
|
4646 N Shallowford Rd Atlanta GA 30338-6308 | |
| (770) 285-7879 | |
| Not Available |
| Full Name | Regenerative Medical Center, Pc |
|---|---|
| Speciality | Pediatrics |
| Location | 4646 N Shallowford Rd, Atlanta, Georgia |
| Authorized Official Name and Position | Joan Olubunmi Ifarinde (DIRECTOR) |
| Authorized Official Contact | 7702857879 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Regenerative Medical Center, Pc 4707 Ashford Dunwoody Rd Unit 468628 Atlanta GA 31146-0117 Ph: (770) 285-7879 | Regenerative Medical Center, Pc 4646 N Shallowford Rd Atlanta GA 30338-6308 Ph: (770) 285-7879 |
| NPI Number | 1992347587 |
|---|---|
| Provider Enumeration Date | 10/15/2019 |
| Last Update Date | 10/13/2020 |
| Medicare PECOS PAC ID | 0840628939 |
|---|---|
| Medicare Enrollment ID | O20200324002375 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992347587 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
| Provider Name | Joan O Ifarinde |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1124095021 PECOS PAC ID: 8820129224 Enrollment ID: I20100629000547 |
| Provider Name | Deandra D Mcduffie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326311895 PECOS PAC ID: 6204264203 Enrollment ID: I20200324003452 |
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