Provider Demographics
NPI:1831337781
Name:REGAL ANESTHESIA, LLC
Entity type:Organization
Organization Name:REGAL ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-280-9977
Mailing Address - Street 1:PO BOX 2197
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31521-2197
Mailing Address - Country:US
Mailing Address - Phone:912-280-9977
Mailing Address - Fax:912-280-9995
Practice Address - Street 1:2500 STARLING ST
Practice Address - Street 2:SUITE 303
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4265
Practice Address - Country:US
Practice Address - Phone:912-280-9977
Practice Address - Fax:912-280-9995
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENUE PLASTIC SURGERY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-30
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty