Provider Demographics
NPI:1659697662
Name:EGOLUM, TONI O'REGGIO (MD)
Entity Type:Individual
Prefix:DR
First Name:TONI
Middle Name:O'REGGIO
Last Name:EGOLUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TONI
Other - Middle Name:ROCHELLE
Other - Last Name:O'REGGIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1485 JESSE JEWELL PKWY NE STE 200
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3802
Mailing Address - Country:US
Mailing Address - Phone:770-534-5255
Mailing Address - Fax:770-287-3871
Practice Address - Street 1:1485 JESSE JEWELL PKWY NE STE 200
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3802
Practice Address - Country:US
Practice Address - Phone:770-534-5255
Practice Address - Fax:770-287-3871
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49746208000000X
390200000X
GA79512208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program