MEDICARE: RENEW HEALTHCARE

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1467387910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEW HEALTHCARE

Provider Business Mailing Address
First Line	:	1640 POWERS FERRY RD SE BUILDING 19, STE 350
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-5491
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 POWERS FERRY RD SE BUILDING 19, STE 350
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-5491
Country	:	US
Telephone Number	:	215-266-2560
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MARLENE PEPUKAYI
Credential	:	NP
Telephone Number	:	215-266-2560

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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Directions to “RENEW HEALTHCARE ” Practice Location

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