MEDICARE: RESURGENS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician		GA

General Provider Information

NPI Number	:	1073640207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESURGENS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 21068
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4107
Country	:	US
Telephone Number	:	404-847-9999
Fax Number	:	404-531-8466

Provider Business Practice Location Address
First Line	:	156 FOSTER DR STE B
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-5330
Country	:	US
Telephone Number	:	770-506-4119
Fax Number	:	770-506-4145

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	VALERIE R SPRINGER
Credential	:
Telephone Number	:	404-531-8615

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	01/31/2023

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