MEDICARE: RESURGENS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1902527021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESURGENS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 21068
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4107
Country	:	US
Telephone Number	:	404-847-9999
Fax Number	:	404-531-8466

Provider Business Practice Location Address
First Line	:	3885 PRINCETON LAKES WAY SW STE 310
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-7100
Country	:	US
Telephone Number	:	470-773-6710
Fax Number	:	470-773-6711

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	VALERIE SPRINGER
Credential	:
Telephone Number	:	404-531-8615

Provider Enumeration Date	:	09/07/2022
Last Update Date	:	03/12/2025

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