Provider Demographics
NPI:1548838485
Name:REGENERATIVE JOINT CLINICS LLC
Entity type:Organization
Organization Name:REGENERATIVE JOINT CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-248-8456
Mailing Address - Street 1:1171 LAUREL POINTE
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7559
Mailing Address - Country:US
Mailing Address - Phone:706-248-8456
Mailing Address - Fax:
Practice Address - Street 1:483 UPPER RIVERDALE RD SW STE F
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2579
Practice Address - Country:US
Practice Address - Phone:706-248-8456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty