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General NPI Number Information
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NPI Number | 1154277929
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Entity Type | Individual
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Provider Name | REGAN DIANE LONG
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Gender | Female
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 4225 UNIVERSITY AVE
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City | COLUMBUS
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State | GA
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Zip | 31907-5679
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Country | US
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Telephone | 706-507-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 2105 COUNTRY RIDGE RD
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City | MILTON
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State | GA
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Zip | 30004
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Country | US
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Telephone | 770-856-4555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN-NP297165
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License Number State | GA
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