Healthcare Provider Details

I. General information

NPI: 1740191253
Provider Name (Legal Business Name): RESURGENS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 VILLAGE PROFESSIONAL DR STE 300
CANTON GA
30114-8499
US

IV. Provider business mailing address

PO BOX 21068
BELFAST ME
04915-4107
US

V. Phone/Fax

Practice location:
  • Phone: 678-880-9472
  • Fax: 678-880-9472
Mailing address:
  • Phone: 404-847-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BOBBI REVETTI
Title or Position: ANCILLARY OPERATIONS EA
Credential:
Phone: 404-575-4901