Healthcare Provider Details

I. General information

NPI: 1922638881
Provider Name (Legal Business Name): REGENTS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 REN MAR DR STE 100
PLEASANT VIEW TN
37146-3723
US

IV. Provider business mailing address

254 REN MAR DR STE 100
PLEASANT VIEW TN
37146-3723
US

V. Phone/Fax

Practice location:
  • Phone: 615-746-0203
  • Fax: 615-746-0001
Mailing address:
  • Phone: 615-746-0203
  • Fax: 615-746-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LORI RAY
Title or Position: PRESIDENT
Credential:
Phone: 615-746-0203