Provider Demographics
NPI:1053735548
Name:GREENFIELD, REGINA (CRNA)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:NORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1359 MILSTEAD RD NE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3865
Mailing Address - Country:US
Mailing Address - Phone:770-388-7745
Mailing Address - Fax:770-922-0526
Practice Address - Street 1:1359 MILSTEAD RD NE
Practice Address - Street 2:SUITE 103
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3865
Practice Address - Country:US
Practice Address - Phone:770-388-7745
Practice Address - Fax:770-922-0526
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN093753367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered