Healthcare Provider Details

I. General information

NPI: 1023148293
Provider Name (Legal Business Name): REGAN J KUDLATA RN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 OLD MILTON PKWY # C STE 190
ALPHARETTA GA
30005-3707
US

IV. Provider business mailing address

1800 HILL CHASE
ALPHARETTA GA
30022-4464
US

V. Phone/Fax

Practice location:
  • Phone: 404-832-0300
  • Fax:
Mailing address:
  • Phone: 770-360-9838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN135173 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: