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General NPI Number Information
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NPI Number | 1952940215
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Entity Type | Organization
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Legal Business Name | KENTUCKY CENTER FOR REGENERATIVE MEDICINE, LLC
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Dates
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Enumeration Date | 01/03/2020
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 4010 DUPONT CIR STE 203
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City | LOUISVILLE
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State | KY
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Zip | 40207-4847
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Country | US
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Telephone | 502-251-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 148 GOLF CREST DR
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City | ACWORTH
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State | GA
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Zip | 30101-5968
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Country | US
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Telephone | 802-734-9455
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Fax | 678-574-5605
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. SANDRA GEILE
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Credential | MD
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Telephone | 502-251-3600
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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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