Healthcare Provider Details

I. General information

NPI: 1053735548
Provider Name (Legal Business Name): REGINA GREENFIELD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REGINA NORTON CRNA

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 MILSTEAD RD NE SUITE 103
CONYERS GA
30012-3865
US

IV. Provider business mailing address

1359 MILSTEAD RD NE SUITE 103
CONYERS GA
30012-3865
US

V. Phone/Fax

Practice location:
  • Phone: 770-388-7745
  • Fax: 770-922-0526
Mailing address:
  • Phone: 770-388-7745
  • Fax: 770-922-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN093753
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: