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General NPI Number Information
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NPI Number | 1649709262
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Entity Type | Organization
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Legal Business Name | ADVANCED REGENERATIVE HEALTHCARE AND PHYSICAL MEDICINE OF BRUNSWICK
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 712 MALL BLVD
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City | BRUNSWICK
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State | GA
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Zip | 31525-0539
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Country | US
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Telephone | 912-262-9735
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Fax | 912-262-9634
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Provider Business Mailing Address
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Address Line | 712 MALL BLVD
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City | BRUNSWICK
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State | GA
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Zip | 31525-0539
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Country | US
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Telephone | 912-262-9735
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Fax | 912-262-9634
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Authorized Official
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Title or Position | OWNER
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Name | RENFRED R. HALVERSON
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Credential | DC, PC
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Telephone | 912-262-9735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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