Provider Demographics
NPI:1609428325
Name:DULUTH REGENERATIVE AND JOINT INSTITUTE LLC
Entity Type:Organization
Organization Name:DULUTH REGENERATIVE AND JOINT INSTITUTE LLC
Other - Org Name:RESTORE FIRST HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HAUPT
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:470-292-3820
Mailing Address - Street 1:330 ARDMORE CIR NW UNIT C118
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1962
Mailing Address - Country:US
Mailing Address - Phone:470-292-3820
Mailing Address - Fax:
Practice Address - Street 1:10680 MEDLOCK BRIDGE RD STE 204
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-8420
Practice Address - Country:US
Practice Address - Phone:470-292-3820
Practice Address - Fax:370-280-9511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty