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General NPI Number Information
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NPI Number | 1770127615
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Entity Type | Organization
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Legal Business Name | JOINT REGENERATION AND ANTI-AGING OF NEWNAN
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Dates
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Enumeration Date | 11/04/2019
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Last Update Date | 04/25/2020
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Provider Practice Location Address
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Address Line | 51 HOSPITAL RD
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City | NEWNAN
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State | GA
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Zip | 30263-1209
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Country | US
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Telephone | 770-251-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 51 HOSPITAL RD
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City | NEWNAN
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State | GA
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Zip | 30263-1209
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Country | US
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Telephone | 770-251-5544
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Fax | 855-552-3776
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Authorized Official
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Title or Position | MBR
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Name | KRYSTIN MANZI
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Credential |
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Telephone | 410-507-5333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0000X
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Taxonomy Name | Pain Management Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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