Provider Demographics
NPI:1275213951
Name:JOINT REGENERATION OF DALTON
Entity Type:Organization
Organization Name:JOINT REGENERATION OF DALTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THUC
Authorized Official - Middle Name:NGUYEN
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:706-936-3361
Mailing Address - Street 1:2006 BARRETT KNOLL CIR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-8209
Mailing Address - Country:US
Mailing Address - Phone:706-936-3361
Mailing Address - Fax:
Practice Address - Street 1:100 W WALNUT AVE STE 116
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8439
Practice Address - Country:US
Practice Address - Phone:706-493-5446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty