Provider Demographics
NPI:1720115066
Name:RESURGENS, LLC
Entity Type:Organization
Organization Name:RESURGENS, LLC
Other - Org Name:RESURGENS ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:R
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:404-531-8466
Practice Address - Street 1:2712 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5910
Practice Address - Country:US
Practice Address - Phone:770-491-3003
Practice Address - Fax:770-491-0729
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESURGENS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-27
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0619450012Medicare NSC