Provider Demographics
NPI:1265830426
Name:RENEW HEALTH AND PHYSICAL MEDICINE
Entity Type:Organization
Organization Name:RENEW HEALTH AND PHYSICAL MEDICINE
Other - Org Name:ALEXANDER SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-297-0901
Mailing Address - Street 1:11705 JONES BRIDGE RD
Mailing Address - Street 2:SUITE D101
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5078
Mailing Address - Country:US
Mailing Address - Phone:678-297-0901
Mailing Address - Fax:678-297-0903
Practice Address - Street 1:11705 JONES BRIDGE RD
Practice Address - Street 2:SUITE D101
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30005-5078
Practice Address - Country:US
Practice Address - Phone:678-297-0901
Practice Address - Fax:678-297-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty