Provider Demographics
NPI:1336329226
Name:WINTERICH, REGINA FALO (PA-C)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:FALO
Last Name:WINTERICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:CHRISTINA
Other - Last Name:FALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 JOHNSON FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1606
Mailing Address - Country:US
Mailing Address - Phone:770-645-9181
Mailing Address - Fax:770-645-8455
Practice Address - Street 1:3155 N POINT PKWY
Practice Address - Street 2:BUILDING F, SUITE 100 ATTN: CREDENTIALING
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-5481
Practice Address - Country:US
Practice Address - Phone:770-645-9181
Practice Address - Fax:770-645-8455
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005210363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I970673Medicare PIN