Organization Active NPI

Joint Regeneration of Dalton

  • Physical Medicine & Rehabilitation Physician
  • Dalton, GA
National Provider Identifier
1275213951
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
JOINT REGENERATION OF DALTON
Practice address
100 W Walnut Ave Ste 116
Dalton, GA 30720-8439
Phone
(706) 493-5446
NPI assigned
Jul 19, 2023
Last updated
Nov 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

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

Authorized official

Name
Thuc Nguyen Doan, NPNPI 1063016590
Title
Manager Owner
Phone
(706) 936-3361

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X NU Primary

Addresses

Primary practice location

100 W Walnut Ave Ste 116
Dalton, GA 30720-8439

Mailing address

2006 Barrett Knoll Cir NW
Kennesaw, GA 30152-8209
Phone (706) 936-3361

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230824001858 GA Part B Supplier - Clinic/Group Practice 5597128561 Receives reassigned benefits from 3 practitioners
Practice locations: Dalton, GA
O20240716000057 GA DME Supplier - Nurse PractitionerDME Supplier - Multi-Specialty - Physician 5597128561 Practice locations: Dalton, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Joint Regeneration of Dalton100 W Walnut Ave, Dalton, GA 30720-8439(706) 493-5446 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf Accepts assignmentParticipating since Aug 16, 2023

National Provider Directory

National Provider Directory

Locations

100 W Walnut Ave
Ste 116
Dalton, GA 30720
Phone (706) 493-5446

1515 W Walnut Ave
Ste 2
Dalton, GA 30720

Practitioners & affiliated clinicians

Practitioners 3

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": "1689724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698796800000",
    "number": "1275213951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2006 BARRETT KNOLL CIR NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301528209",
            "telephone_number": "706-936-3361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W WALNUT AVE STE 116",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307208439",
            "telephone_number": "706-493-5446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOINT REGENERATION OF DALTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-19",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "THUC",
        "authorized_official_middle_name": "NGUYEN",
        "authorized_official_title_or_position": "MANAGER OWNER",
        "authorized_official_telephone_number": "706-936-3361",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dalton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.