Provider Demographics
NPI:1851702153
Name:RESURGIA HEALTH SOLUTIONS PC
Entity Type:Organization
Organization Name:RESURGIA HEALTH SOLUTIONS PC
Other - Org Name:RESURGIA HEALTH SOLUTIONS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GM
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-445-5304
Mailing Address - Street 1:1100 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4501
Mailing Address - Country:US
Mailing Address - Phone:404-445-5304
Mailing Address - Fax:404-445-5173
Practice Address - Street 1:1100 PEACHTREE ST NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-4501
Practice Address - Country:US
Practice Address - Phone:404-445-5304
Practice Address - Fax:404-445-5173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003238842AMedicaid