Provider Demographics
NPI:1982082525
Name:AMELL, REGINA INGRAM (MASTER COSMETOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:INGRAM
Last Name:AMELL
Suffix:
Gender:F
Credentials:MASTER COSMETOLOGIST
Other - Prefix:MRS
Other - First Name:REGINA
Other - Middle Name:INGRAM
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASTER COSMETOLOGIST
Mailing Address - Street 1:11770 HAYNES BRIDGE RD
Mailing Address - Street 2:SUITE 401 ROOM 48
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1966
Mailing Address - Country:US
Mailing Address - Phone:520-255-3024
Mailing Address - Fax:
Practice Address - Street 1:11770 HAYNES BRIDGE RD
Practice Address - Street 2:SUITE 401 ROOM 48
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1966
Practice Address - Country:US
Practice Address - Phone:520-255-3024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment