Healthcare Provider Details

I. General information

NPI: 1073274817
Provider Name (Legal Business Name): JOINT REGENERATION OF LAKE OCONEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 MARS HILL RD STE B
WATKINSVILLE GA
30677-4889
US

IV. Provider business mailing address

1612 MARS HILL RD STE B
WATKINSVILLE GA
30677-4889
US

V. Phone/Fax

Practice location:
  • Phone: 762-220-1199
  • Fax:
Mailing address:
  • Phone: 706-705-1464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATTY STEWART
Title or Position: OWNER
Credential:
Phone: 706-705-1464