Healthcare Provider Details

I. General information

NPI: 1720375165
Provider Name (Legal Business Name): REGINA F AYENI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVE
ATHENS GA
30606-2797
US

IV. Provider business mailing address

PO BOX 705
POWDER SPRINGS GA
30127-0705
US

V. Phone/Fax

Practice location:
  • Phone: 478-464-8134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN143045
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberRN143045
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: