# SPRINGS REJUVENATION LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Springs Rejuvenation
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114613759
- **Authorized official:** DIANA REEDER BSHA, CCMA, CBCS (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (470) 589-7120

## Contact information

- **Practice address:** 420 E 3RD ST STE 705, LOS ANGELES, CA 90013-1646
- **Practice address phone:** (404) 780-5617
- **Mailing address:** 4411 SUWANEE DAM RD STE 440, SUWANEE, GA 30024-8706
- **Mailing address phone:** (470) 589-7120
- **Mailing address fax:** (844) 350-6954

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PS0010X | Sports Medicine (Emergency Medicine) Physician | — | NULL | — |
| 207PS0010X | Sports Medicine (Emergency Medicine) Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 208800000X | Urology Physician | — | NULL | — |
| 208800000X | Urology Physician | — | — | — |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 04/17/2023
- **Last updated:** 01/17/2024