Provider Demographics
NPI:1265597835
Name:REGIONAL FIRSTCARE INC
Entity type:Organization
Organization Name:REGIONAL FIRSTCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RANSFORD-DES JARDINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-475-4921
Mailing Address - Street 1:1500 OGLETHORPE AVE
Mailing Address - Street 2:STE 600A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2179
Mailing Address - Country:US
Mailing Address - Phone:706-475-4920
Mailing Address - Fax:706-208-8259
Practice Address - Street 1:1010 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-6004
Practice Address - Country:US
Practice Address - Phone:706-769-0000
Practice Address - Fax:706-769-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027103207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3190OtherMEDICARE GROUP NUMBER