Healthcare Provider Details

I. General information

NPI: 1154277929
Provider Name (Legal Business Name): REGAN DIANE LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NORTHSIDE FORSYTH DR STE 450
CUMMING GA
30041-8483
US

IV. Provider business mailing address

PO BOX 117598
ATLANTA GA
30368-7598
US

V. Phone/Fax

Practice location:
  • Phone: 678-947-6440
  • Fax: 678-513-4764
Mailing address:
  • Phone: 770-442-1911
  • Fax: 770-442-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP297165
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: