Provider Demographics
NPI:1053849448
Name:RESURGENS, LLC
Entity Type:Organization
Organization Name:RESURGENS, LLC
Other - Org Name:RESURGENS ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-531-8615
Mailing Address - Street 1:PO BOX 21068
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4107
Mailing Address - Country:US
Mailing Address - Phone:404-847-9999
Mailing Address - Fax:
Practice Address - Street 1:1495 HICKORY FLAT HWY STE 200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-4229
Practice Address - Country:US
Practice Address - Phone:678-505-4455
Practice Address - Fax:678-505-4446
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESURGENS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-30
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty