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General NPI Number Information
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NPI Number | 1053697714
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Entity Type | Organization
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Legal Business Name | SALLY W REGAN MD PC
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 1 MEDICAL PARK DR
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City | CHESTER
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State | SC
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Zip | 29706-9769
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Country | US
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Telephone | 803-581-9413
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5938
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City | CHATTANOOGA
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State | TN
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Zip | 37406-0938
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Country | US
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Telephone | 423-826-1276
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Fax | 423-826-1290
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Authorized Official
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Title or Position | OWNER
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Name | SALLY REGAN
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Credential | MD
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Telephone | 423-826-1276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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