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General NPI Number Information
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NPI Number | 1750996302
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Entity Type | Organization
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Legal Business Name | SOUTH FULTON REGENERATIVE MEDICINE AND PHYSICAL REHABILITATION
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 5835 CAMPBELLTON RD SW STE 204
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City | ATLANTA
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State | GA
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Zip | 30331-8014
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Country | US
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Telephone | 404-349-3601
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Fax |
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Provider Business Mailing Address
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Address Line | 5835 CAMPBELLTON RD SW STE 204
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City | ATLANTA
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State | GA
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Zip | 30331-8014
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Country | US
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Telephone | 404-349-3601
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAWN G JONES
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Credential | DC
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Telephone | 404-349-3601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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