Provider Demographics
NPI:1669981049
Name:RESURGENS, LLC
Entity type:Organization
Organization Name:RESURGENS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-531-8615
Mailing Address - Street 1:PO BOX 21068
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4107
Mailing Address - Country:US
Mailing Address - Phone:404-847-9999
Mailing Address - Fax:
Practice Address - Street 1:4450 CALIBRE XING NW STE 1225
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4103
Practice Address - Country:US
Practice Address - Phone:704-915-4817
Practice Address - Fax:770-491-5482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty