MEDICARE: THE REGENERATION PROJECT

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114253416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE REGENERATION PROJECT

Provider Business Mailing Address
First Line	:	378 TABOR RD
Second Line	:
City	:	FORT VALLEY
State	:	GA
Zip	:	31030-6024
Country	:	US
Telephone Number	:	478-971-4684
Fax Number	:

Provider Business Practice Location Address
First Line	:	378 TABOR RD
Second Line	:
City	:	FORT VALLEY
State	:	GA
Zip	:	31030-6024
Country	:	US
Telephone Number	:	478-971-4684
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MS. BRENDA WILLIAMS
Credential	:
Telephone Number	:	478-971-4684

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	10/22/2009

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Directions to “THE REGENERATION PROJECT ” Practice Location

Language	Start Address	Practice Location

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