Healthcare Provider Details

I. General information

NPI: 1376597161
Provider Name (Legal Business Name): REGINA MORGAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 WATSON BLVD
WARNER ROBINS GA
31093-8536
US

IV. Provider business mailing address

202 OLD JAMES RD
GRAY GA
31032-3551
US

V. Phone/Fax

Practice location:
  • Phone: 478-953-4563
  • Fax: 478-953-4564
Mailing address:
  • Phone: 478-932-8150
  • Fax: 478-932-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN097019
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN097019
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: