Healthcare Provider Details

I. General information

NPI: 1831349703
Provider Name (Legal Business Name): MIRRIN E REAGAN RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5909 PEACHTREE DUNWOODY RD NE STE 720
ATLANTA GA
30328-8102
US

IV. Provider business mailing address

5909 PEACHTREE DUNWOODY RD NE STE 720
ATLANTA GA
30328-8102
US

V. Phone/Fax

Practice location:
  • Phone: 770-928-2276
  • Fax: 770-592-2092
Mailing address:
  • Phone: 770-928-2276
  • Fax: 770-592-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN150756
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code364SP1700X
TaxonomyPerinatal Clinical Nurse Specialist
License NumberRN150756
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: