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General NPI Number Information
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NPI Number | 1073274817
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Entity Type | Organization
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Legal Business Name | JOINT REGENERATION OF LAKE OCONEE LLC
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 1612 MARS HILL RD STE B
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City | WATKINSVILLE
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State | GA
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Zip | 30677-4889
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Country | US
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Telephone | 762-220-1199
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Fax |
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Provider Business Mailing Address
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Address Line | 1612 MARS HILL RD STE B
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City | WATKINSVILLE
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State | GA
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Zip | 30677-4889
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Country | US
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Telephone | 706-705-1464
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PATTY STEWART
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Credential |
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Telephone | 706-705-1464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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