Provider Demographics
NPI:1073560959
Name:JUSTICE, REGINA P (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:P
Last Name:JUSTICE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2462 HIGHWAY 34 EAST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265
Mailing Address - Country:US
Mailing Address - Phone:770-683-5437
Mailing Address - Fax:770-683-3758
Practice Address - Street 1:2462 HIGHWAY 34 EAST
Practice Address - Street 2:SUITE A
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265
Practice Address - Country:US
Practice Address - Phone:770-683-5437
Practice Address - Fax:770-683-3758
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2013-04-04
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Provider Licenses
StateLicense IDTaxonomies
GA047777208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000912975NMedicaid