Healthcare Provider Details

I. General information

NPI: 1265774673
Provider Name (Legal Business Name): SARA NICOLE REGGIE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2013
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 MADISON AVE STE 200
MEMPHIS TN
38103
US

IV. Provider business mailing address

1407 UNION AVE STE 700
MEMPHIS TN
38104-3641
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-6650
  • Fax:
Mailing address:
  • Phone: 901-866-8003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD461515
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number57501
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License NumberMD461515
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number57501
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: