Healthcare Provider Details

I. General information

NPI: 1366985335
Provider Name (Legal Business Name): REGINA MCBRIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 PALM SPRINGS DR
EAST POINT GA
30344-6521
US

IV. Provider business mailing address

4250 PALM SPRINGS DR
EAST POINT GA
30344-6521
US

V. Phone/Fax

Practice location:
  • Phone: 404-362-7965
  • Fax:
Mailing address:
  • Phone: 404-362-7965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: