Healthcare Provider Details

I. General information

NPI: 1740218890
Provider Name (Legal Business Name): REGINA K. PHILLIPS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. REGINA P. GILLILAND

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10680 MEDLOCK BRIDGE RD STE 204
JOHNS CREEK GA
30097-8420
US

IV. Provider business mailing address

10680 MEDLOCK BRIDGE RD STE 101
JOHNS CREEK GA
30097-8420
US

V. Phone/Fax

Practice location:
  • Phone: 470-292-3820
  • Fax:
Mailing address:
  • Phone: 470-292-3820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13714
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number13714
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: