Provider Demographics
NPI:1114042066
Name:SYED, REGINA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:MARIE
Last Name:SYED
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 DEVON BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6701
Mailing Address - Country:US
Mailing Address - Phone:770-928-8768
Mailing Address - Fax:
Practice Address - Street 1:4180 OLD MILTON PKWY
Practice Address - Street 2:STE. 1-C
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2408
Practice Address - Country:US
Practice Address - Phone:770-754-1000
Practice Address - Fax:770-754-1010
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHSQMedicare ID - Type Unspecified