Ageless Center of Regenerative & Wellness Medicine

Primary specialty

Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X

License

GA045023 Issued in GA

Legal business name

AGELESS CENTER OF REGENERATIVE & WELLNESS MEDICINE

Practice address

1000 Commerce Dr
Suite 300
Peachtree City, GA 30269-3530

Phone

(678) 364-8414

Fax

(678) 545-0146

NPI assigned

Aug 18, 2015

Last updated

Aug 18, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Linda Faulkner, N.P.

Title

Coo

Phone

(678) 364-8414

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Jamie W Walraven, MD

  • Emergency Medicine Physician
  • Peachtree City, GA
  • NPI 1750328738
  NPD (past)

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

{
    "created_epoch": "1439856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439856000000",
    "number": "1588030100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 COMMERCE DR",
            "address_2": "SUITE 300",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302693530",
            "telephone_number": "678-364-8414",
            "fax_number": "678-545-0146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 COMMERCE DR",
            "address_2": "SUITE 300",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302693530",
            "telephone_number": "678-364-8414",
            "fax_number": "678-545-0146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGELESS CENTER OF REGENERATIVE & WELLNESS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-18",
        "last_updated": "2015-08-18",
        "status": "A",
        "authorized_official_last_name": "FAULKNER",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "678-364-8414",
        "authorized_official_credential": "N.P."
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "GA",
            "license": "GA045023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Advanced Chiropractic Health Center, Inc
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• Aesthetic Restorative Dentistry, P. C.
• Affirm Counseling Services
• Affordable Dental
• Ageless Women's Health Ga LLC
• Ruchir Agrawal
• Andrew C Agwunobi, MD
• Jude Agyeman
• Zouhal Ahmadi, PHARMD

• Public Health & General Preventive Medicine Physician in Peachtree City, GA
• Providers in Peachtree City, GA by specialty
• Public Health & General Preventive Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; 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.