Healthcare Provider Details

I. General information

NPI: 1316580145
Provider Name (Legal Business Name): REGENERATIVE HEALTH SOLUTIONS CHIROPRACTIC, NUTRITION, DETOXIFICATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3823 ROSWELL RD STE 202
MARIETTA GA
30062-6278
US

IV. Provider business mailing address

3823 ROSWELL RD STE 202
MARIETTA GA
30062-6278
US

V. Phone/Fax

Practice location:
  • Phone: 678-383-6643
  • Fax: 877-395-6761
Mailing address:
  • Phone: 678-383-6643
  • Fax: 877-395-6761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MALCOLM WARREN
Title or Position: OWNER
Credential: DC
Phone: 229-444-3127