Provider Demographics
NPI:1952576571
Name:REGIONAL HEALTH GROUP INC
Entity type:Organization
Organization Name:REGIONAL HEALTH GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:229-405-2470
Mailing Address - Street 1:2311 LAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707
Mailing Address - Country:US
Mailing Address - Phone:229-435-0525
Mailing Address - Fax:229-434-9827
Practice Address - Street 1:2311 LAKE PARK DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707
Practice Address - Country:US
Practice Address - Phone:229-435-0525
Practice Address - Fax:229-434-9827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2023-01-27
Deactivation Date:2022-11-04
Deactivation Code:
Reactivation Date:2022-12-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID
F41795Medicare UPIN
GA=========OtherTAX ID
GA4738730001Medicare NSC