Active NPI
Joint Regeneration & Anti-Aging of
- Multi-Specialty Clinic/Center
- Peachtree City, GA
National Provider Identifier
1073116554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Multi-Specialty Clinic/Center
- Legal business name
- JOINT REGENERATION & ANTI-AGING OF
- Practice address
- 1601 Georgian Park Ste Terrace
Peachtree City, GA 30269-6968 - Phone
- (770) 683-4495
- NPI assigned
- Nov 18, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kristyn Manzi
- Title
- Owner
- Phone
- (770) 683-4495
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Primary | ||
| Medical Specialty Clinic/Center | 261QM2500X |
Addresses
Primary practice location
1601 Georgian Park Ste Terrace
Peachtree City, GA 30269-6968
Mailing address
1601 Georgian Park Ste Terrace
Peachtree City, GA 30269-6968
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201203002328 | GA | Part B Supplier - Clinic/Group Practice | 8527479021 |
Receives reassigned benefits from 10 practitioners Practice locations: Peachtree City, GA |
| O20210402000635 | GA | DME Supplier - Multi-Specialty - Physician | 8527479021 | Practice locations: Peachtree City, GA |
National Provider Directory
National Provider DirectoryLocations
1601 Georgian Park
Peachtree City, GA 30269
Phone (770) 487-5346
1601 Georgian Park
Ste Ter
Peachtree Cty, GA 30269
Phone (678) 834-5526
Practitioners & affiliated clinicians
Practitioners 12
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Riverdale, MD
- NPI 1184782369
-
- Registered Nurse
- Rome, GA
- NPI 1861130874
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605657600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1606089600000",
"number": "1073116554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 GEORGIAN PARK STE TERRACE",
"city": "PEACHTREE CITY",
"state": "GA",
"postal_code": "302696968"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 GEORGIAN PARK STE TERRACE",
"city": "PEACHTREE CITY",
"state": "GA",
"postal_code": "302696968",
"telephone_number": "770-683-4495"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JOINT REGENERATION & ANTI-AGING OF",
"organizational_subpart": "NO",
"enumeration_date": "2020-11-18",
"last_updated": "2020-11-23",
"certification_date": "2020-11-23",
"status": "A",
"authorized_official_last_name": "MANZI",
"authorized_official_first_name": "KRISTYN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "770-683-4495"
},
"taxonomies": [
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QM2500X",
"taxonomy_group": "",
"desc": "Clinic/Center, Medical Specialty",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peachtree City, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.