Provider Demographics
NPI:1982606570
Name:REGENCY HOSPITAL OF HATTIESBURG, LLC
Entity Type:Organization
Organization Name:REGENCY HOSPITAL OF HATTIESBURG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF STRATEGY OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:W.
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-777-2602
Mailing Address - Street 1:11175 CICERO DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1148
Mailing Address - Country:US
Mailing Address - Phone:770-772-4345
Mailing Address - Fax:770-772-9192
Practice Address - Street 1:125 S 25TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-6031
Practice Address - Country:US
Practice Address - Phone:601-288-8510
Practice Address - Fax:601-288-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22-333282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
25-2009Medicare ID - Type Unspecified