Organization
REGENESIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES IVY LEE MD (PHYSICIAN/OWNER)
(256) 715-8193
Entity
Organization
Contact information
Practice address
300 RANDOLPH AVE SE, HUNTSVILLE, AL 35801-4118
(256) 715-8193
Mailing address
300 RANDOLPH AVE SE, HUNTSVILLE, AL 35801-4118
(256) 715-8193
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
14864
AL
Other
Enumeration date
08/11/2016
Last updated
08/11/2016
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