Healthcare Provider Details

I. General information

NPI: 1154862894
Provider Name (Legal Business Name): REGINA ANN STONE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 SHIRLEY AVE
DOUGLAS GA
31533-2123
US

IV. Provider business mailing address

1003 SHIRLEY AVE
DOUGLAS GA
31533-2123
US

V. Phone/Fax

Practice location:
  • Phone: 912-389-4586
  • Fax: 912-389-4590
Mailing address:
  • Phone: 912-389-4586
  • Fax: 912-389-4590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN113482
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: