Provider Demographics
NPI:1114960952
Name:RENEWAL, INC
Entity Type:Organization
Organization Name:RENEWAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GOBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-719-9900
Mailing Address - Street 1:377 FAYETTE PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1653
Mailing Address - Country:US
Mailing Address - Phone:770-719-9900
Mailing Address - Fax:770-716-7616
Practice Address - Street 1:1831 5TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8915
Practice Address - Country:US
Practice Address - Phone:706-320-8766
Practice Address - Fax:706-320-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherFED TAX ID
GA1211220003Medicare ID - Type Unspecified