=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265597835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGIONAL FIRSTCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2006
-----------------------------------------------------
Last Update Date | 12/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 VILLAGE DR
-----------------------------------------------------
City | WATKINSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30677-6004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-769-0000
-----------------------------------------------------
Fax | 706-769-0320
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 OGLETHORPE AVE STE 600A
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30606-2179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-475-4920
-----------------------------------------------------
Fax | 706-208-8259
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE DIRECTOR
-----------------------------------------------------
Name | SHELLEY RANSFORD-DES JARDINES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-475-4921
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 027103
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------