Healthcare Provider Details

I. General information

NPI: 1538945910
Provider Name (Legal Business Name): REGENCELL OF EAST ALABAMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 GATEWOOD DR
AUBURN AL
36830-2834
US

IV. Provider business mailing address

1365 GATEWOOD DR
AUBURN AL
36830-2834
US

V. Phone/Fax

Practice location:
  • Phone: 334-646-1418
  • Fax:
Mailing address:
  • Phone: 334-646-1418
  • Fax: 334-521-7117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARIA TUCKER
Title or Position: DIRECTOR OF CLINICAL OPERATIONS
Credential: REGISTERED NURSE
Phone: 334-646-1418