| Regencell Metabolics | |
|
1365 Gatewood Dr Auburn AL 36830-2834 | |
| (334) 646-1418 | |
| Not Available |
| Full Name | Regencell Metabolics |
|---|---|
| Speciality | Clinic/Center |
| Location | 1365 Gatewood Dr, Auburn, Alabama |
| Authorized Official Name and Position | Maria Tucker (DIRECTOR OF CLINICAL OPERATIONS) |
| Authorized Official Contact | 3346461418 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Regencell Metabolics 1365 Gatewood Dr Auburn AL 36830-2834 Ph: (334) 646-1418 | Regencell Metabolics 1365 Gatewood Dr Auburn AL 36830-2834 Ph: (334) 646-1418 |
| NPI Number | 1538945910 |
|---|---|
| Provider Enumeration Date | 09/01/2023 |
| Last Update Date | 05/09/2024 |
| Certification Date | 05/09/2024 |
| Medicare PECOS PAC ID | 1052831146 |
|---|---|
| Medicare Enrollment ID | O20250219002609 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538945910 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Primary |
| 163WI0500X | Registered Nurse - Infusion Therapy | (NU) | Secondary |
| Provider Name | Keith L Fuller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730125527 PECOS PAC ID: 9335100148 Enrollment ID: I20051128000429 |
| Provider Name | Laura Walton Bell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629519558 PECOS PAC ID: 9931532199 Enrollment ID: I20191203000969 |
| Provider Name | Anna Petty Gardner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265008312 PECOS PAC ID: 8628476371 Enrollment ID: I20211011000118 |
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