Healthcare Provider Details

I. General information

NPI: 1659486975
Provider Name (Legal Business Name): REGINA TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 MILLVALE CT
LAWRENCEVILLE GA
30044-6237
US

IV. Provider business mailing address

1348 MILLVALE CT
LAWRENCEVILLE GA
30044-6237
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN076270
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: