Healthcare Provider Details

I. General information

NPI: 1659697662
Provider Name (Legal Business Name): TONI O'REGGIO EGOLUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONI ROCHELLE O'REGGIO M.D.

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 JESSE JEWELL PKWY NE STE 200
GAINESVILLE GA
30501-3802
US

IV. Provider business mailing address

1485 JESSE JEWELL PKWY NE STE 200
GAINESVILLE GA
30501-3802
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-5255
  • Fax: 770-287-3871
Mailing address:
  • Phone: 770-534-5255
  • Fax: 770-287-3871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49746
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number79512
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: