Healthcare Provider Details

I. General information

NPI: 1831337781
Provider Name (Legal Business Name): REGAL ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 STARLING ST SUITE 303
BRUNSWICK GA
31520-4265
US

IV. Provider business mailing address

PO BOX 2197
BRUNSWICK GA
31521-2197
US

V. Phone/Fax

Practice location:
  • Phone: 912-280-9977
  • Fax: 912-280-9995
Mailing address:
  • Phone: 912-280-9977
  • Fax: 912-280-9995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: CHARLES WILLIAM MITCHELL
Title or Position: MEMBER, MANAGER
Credential: M.D.
Phone: 912-280-9977