MEDICARE: MS. REGINA D PHILLIPS

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	343900000X	Non-emergency Medical Transport (VAN)	431983029	GA
2	347C00000X	Private Vehicle	431983029	GA
3	163W00000X	Registered Nurse	RN232977	GA
4	1744P3200X	Prosthetics Case Management	431983029	GA
5	1744P3200X	Prosthetics Case Management	431983029	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891173324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REGINA D PHILLIPS

Provider Business Mailing Address
First Line	:	1011 EAGLES RIDGE CT
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-2825
Country	:	US
Telephone Number	:	513-237-8098
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 EAGLES RIDGE CT
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-4196
Country	:	US
Telephone Number	:	513-237-8089
Fax Number	:

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

Provider Enumeration Date	:	05/17/2015
Last Update Date	:	10/07/2016

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