Provider Demographics
NPI:1689743270
Name:DRUMGOOLE, REGINALD (RN-NP)
Entity Type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:
Last Name:DRUMGOOLE
Suffix:
Gender:M
Credentials:RN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 GREAT SHOALS CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7098
Mailing Address - Country:US
Mailing Address - Phone:404-271-3326
Mailing Address - Fax:404-296-4661
Practice Address - Street 1:1400 BUFORD HWY # R10
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8721
Practice Address - Country:US
Practice Address - Phone:404-294-7033
Practice Address - Fax:404-296-4661
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN129801363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ46979Medicare UPIN
GA50BBJLKMedicare ID - Type Unspecified