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General NPI Number Information
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NPI Number | 1992347587
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Entity Type | Organization
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Legal Business Name | REGENERATIVE MEDICAL CENTER, PC
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 4646 N SHALLOWFORD RD
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City | ATLANTA
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State | GA
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Zip | 30338-6308
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Country | US
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Telephone | 770-285-7879
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Fax |
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Provider Business Mailing Address
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Address Line | 4707 ASHFORD DUNWOODY RD UNIT 468628
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City | ATLANTA
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State | GA
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Zip | 31146-0117
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Country | US
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Telephone | 770-285-7879
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOAN OLUBUNMI IFARINDE
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Credential | MD
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Telephone | 770-285-7879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 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 #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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