1043456205 NPI number — RESURGENS, LLC

Table of content: (NPI 1043456205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043456205 NPI number — RESURGENS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESURGENS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043456205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-847-9999
Provider Business Mailing Address Fax Number:
404-531-8466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3698 LARGENT WAY NW
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30064-5923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-354-2883
Provider Business Practice Location Address Fax Number:
678-933-0600
Provider Enumeration Date:
12/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SPRINGER
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
404-531-8615

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com