Healthcare Provider Details

I. General information

NPI: 1689743270
Provider Name (Legal Business Name): REGINALD DRUMGOOLE R.N.-N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BUFORD HWY # R10
BUFORD GA
30518-8721
US

IV. Provider business mailing address

1523 GREAT SHOALS CIR
LAWRENCEVILLE GA
30045-7098
US

V. Phone/Fax

Practice location:
  • Phone: 404-294-7033
  • Fax: 404-296-4661
Mailing address:
  • Phone: 404-271-3326
  • Fax: 404-296-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN129801
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: