MEDICARE: REGENCY HOSPICE OF GEORGIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	111637	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760440424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENCY HOSPICE OF GEORGIA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 4060
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-4060
Country	:	US
Telephone Number	:	704-644-2876
Fax Number	:

Provider Business Practice Location Address
First Line	:	2924 PROFESSIONAL PKWY
Second Line	:	SUITE A
City	:	AUGUSTA
State	:	GA
Zip	:	30907-6529
Country	:	US
Telephone Number	:	706-868-4422
Fax Number	:	706-868-4424

Authorized Official
Title or Position	:	VP OF LEGAL AFFAIRS
Name	:	JANET COMBS
Credential	:
Telephone Number	:	913-814-2013

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	05/23/2023

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