Basic Information
| Provider Information | |||||||||
| NPI: | 1376597161 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORGAN | ||||||||
| FirstName: | REGINA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 OLD JAMES RD | ||||||||
| Address2: | |||||||||
| City: | GRAY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310323551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789328150 | ||||||||
| FaxNumber: | 4789320101 | ||||||||
| Practice Location | |||||||||
| Address1: | 3051 WATSON BLVD | ||||||||
| Address2: | |||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310938536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789534563 | ||||||||
| FaxNumber: | 4789534564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 02/11/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN097019 | GA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | RN097019 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 000968338B | 05 | GA | MEDICAID | 000968338C | 05 | GA | MEDICAID | 000968338D | 05 | GA | MEDICAID |