Provider Demographics
NPI:1114613759
Name:SPRINGS REJUVENATION LLC
Entity Type:Organization
Organization Name:SPRINGS REJUVENATION LLC
Other - Org Name:SPRINGS REJUVENATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:REEDER
Authorized Official - Suffix:
Authorized Official - Credentials:BSHA, CCMA, CBCS
Authorized Official - Phone:470-589-7120
Mailing Address - Street 1:4411 SUWANEE DAM RD STE 440
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8706
Mailing Address - Country:US
Mailing Address - Phone:470-589-7120
Mailing Address - Fax:844-350-6954
Practice Address - Street 1:420 E 3RD ST STE 705
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1646
Practice Address - Country:US
Practice Address - Phone:404-780-5617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty