MEDICARE: REGAN DIANE LONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN-NP297165	GA

General Provider Information

NPI Number	:	1154277929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGAN DIANE LONG

Provider Business Mailing Address
First Line	:	2105 COUNTRY RIDGE RD
Second Line	:
City	:	MILTON
State	:	GA
Zip	:	30004
Country	:	US
Telephone Number	:	770-856-4555
Fax Number	:

Provider Business Practice Location Address
First Line	:	4225 UNIVERSITY AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-5679
Country	:	US
Telephone Number	:	706-507-8800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ REGAN DIANE LONG ” Practice Location

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