Organization
JOINT REGENERATION GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL E BANNISTER (OWNER)
(770) 864-8423
Entity
Organization
Contact information
Practice address
104 WHITING WAY # 210-220, WARNER ROBINS, GA 31088-8054
(478) 333-1346
Mailing address
9000 WATSON BLVD APT 1103, BYRON, GA 31008-3797
(770) 864-8423
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Enumeration date
06/07/2021
Last updated
09/14/2021
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