Basic Information
| Provider Information | |||||||||
| NPI: | 1821511676 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESURGENS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4150 DEPUTY BILL CANTRELL MEMORIAL ROAD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30040 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4441 ATLANTA RD SE STE 207 | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300806537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0000000000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2017 | ||||||||
| LastUpdateDate: | 07/24/2017 | ||||||||
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| AuthorizedOfficialLastName: | ZAMONIS | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7703600449 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RESURGENS, PC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.