NPIMap

Organization Active NPI

Joint Regeneration & Anti-Aging of

  • Multi-Specialty Clinic/Center
  • Peachtree City, GA
National Provider Identifier
1073116554
Registry record updated Nov 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
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
Last updated
Nov 23, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2020

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)CodeLicenseStatePrimary
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 GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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 Directory

Locations

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, and the practitioner matching its NPPES authorized official.

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.

Verify at the official NPI Registry.