# JOINT REGENERATION GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831766138
- **Authorized official:** MICHAEL E BANNISTER (OWNER)
- **Authorized official phone:** (770) 864-8423

## Contact information

- **Practice address:** 104 WHITING WAY \# 210-220, WARNER ROBINS, GA 31088-8054
- **Practice address phone:** (478) 333-1346
- **Mailing address:** 9000 WATSON BLVD APT 1103, BYRON, GA 31008-3797
- **Mailing address phone:** (770) 864-8423

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 06/07/2021
- **Last updated:** 09/14/2021