Renew Wellness Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

048349 Issued in GA

Legal business name

RENEW WELLNESS INC

Practice address

11348 Tara Blvd
Ste 100
Hampton, GA 30228-6277

Phone

(678) 466-6424

Fax

(678) 466-6464

NPI assigned

Feb 4, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stacy Petit

Title

Owner

Phone

(678) 615-4029

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454544000000",
    "number": "1053779058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11348 TARA BLVD",
            "address_2": "STE 100",
            "city": "HAMPTON",
            "state": "GA",
            "postal_code": "302286277",
            "telephone_number": "678-466-6424",
            "fax_number": "678-466-6464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11348 TARA BLVD",
            "address_2": "STE 100",
            "city": "HAMPTON",
            "state": "GA",
            "postal_code": "302286277",
            "telephone_number": "678-466-6424",
            "fax_number": "678-466-6464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW WELLNESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-04",
        "last_updated": "2016-02-04",
        "status": "A",
        "authorized_official_last_name": "PETIT",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-615-4029"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "048349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keisha N Ray, BC-TMH, LMSW
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• Family Medicine Physician in Hampton, GA
• Providers in Hampton, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.