Organization Name: | REGAIL'S ENTERPRISES |
NPI Number: | 1033582713 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GEORGETTE ANTHONY (ASSISTANT) |
Mailing Address: | 5116 Verbena Dr Nw Acworth |
State: | GA US |
Postal Code: | 301026923 |
Phone Number: | 7706308997 |
Fax Number: | |
NPI Enumeration Date: | 11/04/2015 |
NPI Last Update Date: | 11/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |