Organization
RENEW HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN EDWARD OUELLETTE (MANAGING MEMBER)
(678) 297-0901
Entity
Organization
Contact information
Practice address
11550 JONES BRIDGE RD, SUITE 4, ALPHARETTA, GA 30022-4540
(678) 297-0901
Mailing address
11550 JONES BRIDGE RD, SUITE 4, ALPHARETTA, GA 30022-4540
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
038955
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202G708437
PTAN
GA
Enumeration date
02/17/2011
Last updated
10/06/2011
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