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General NPI Number Information
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NPI Number | 1841769718
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Entity Type | Organization
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Legal Business Name | REGENERATIVE HEALTHCARE, LLC
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Dates
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Enumeration Date | 11/20/2018
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 329 EISENHOWER DR STE D
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City | SAVANNAH
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State | GA
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Zip | 31406-2695
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Country | US
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Telephone | 912-661-0450
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Fax | 912-348-3104
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Provider Business Mailing Address
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Address Line | 114 CANAL ST STE 603
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City | POOLER
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State | GA
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Zip | 31322-4292
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Country | US
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Telephone | 912-665-6217
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Fax | 912-348-3104
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | SHELLEY WILKINS
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Credential |
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Telephone | 912-655-6217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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