OrganizationActive
Ageless Center of Regenerative & Wellness Medicine
NPI 1588030100 · Public Health & General Preventive Medicine Physician · Peachtree City, GA
Provider details
- NPI number
- 1588030100
- Entity type
- Organization
- Primary specialty
- Public Health & General Preventive Medicine PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Linda Faulkner, Coo
- License
- GA045023 (GA)
Practice location
1000 Commerce Dr
Suite 300
Peachtree City, GA 30269-3530
Phone: (678) 364-8414
Fax: (678) 545-0146
Mailing address
1000 Commerce Dr
Peachtree City, GA 30269-3530
Registry dates
- Enumerated
- 2015-08-18
- Last updated
- 2015-08-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.