Healthcare Provider Details

I. General information

NPI: 1225292659
Provider Name (Legal Business Name): REGIONAL HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 VIRGINIA AVE
COLLEGE PARK GA
30337
US

IV. Provider business mailing address

PO BOX 500067
ATLANTA GA
31150
US

V. Phone/Fax

Practice location:
  • Phone: 404-781-2225
  • Fax: 404-781-2226
Mailing address:
  • Phone: 678-701-2225
  • Fax: 678-701-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICIA BENTON
Title or Position: CEO
Credential: MD
Phone: 678-701-2225