| West Georgia Regenerative Medicine Llc | |
|
3624 Edgewood Rd Ste B Columbus GA 31907 | |
| (762) 204-4103 | |
| Not Available |
| Full Name | West Georgia Regenerative Medicine Llc |
|---|---|
| Speciality | General Practice |
| Location | 3624 Edgewood Rd Ste B, Columbus, Georgia |
| Authorized Official Name and Position | Michael Haniotis (AUTHORIZED OFFICIAL/PARTNER) |
| Authorized Official Contact | 7622044103 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Georgia Regenerative Medicine Llc 3624 Edgewood Rd Ste B Columbus GA 31907-8238 Ph: (762) 204-4103 | West Georgia Regenerative Medicine Llc 3624 Edgewood Rd Ste B Columbus GA 31907 Ph: (762) 204-4103 |
| NPI Number | 1629555172 |
|---|---|
| Provider Enumeration Date | 07/26/2018 |
| Last Update Date | 07/31/2018 |
| Medicare PECOS PAC ID | 6507116589 |
|---|---|
| Medicare Enrollment ID | O20180912003124 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629555172 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 225100000X | Physical Therapist | (* (Not Available)) | Secondary |
| Provider Name | Najeeb I Siddique |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1558313726 PECOS PAC ID: 2961307103 Enrollment ID: I20041215000975 |
| Provider Name | Jorge O Pabia |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1316016298 PECOS PAC ID: 7911071881 Enrollment ID: I20140312000866 |
| Provider Name | Maegan Bell Huff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487177168 PECOS PAC ID: 5496011777 Enrollment ID: I20171102003206 |
| Provider Name | Marissa Sellers |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1275015083 PECOS PAC ID: 6305199696 Enrollment ID: I20181103000017 |
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