Provider Demographics
NPI:1740218890
Name:PHILLIPS, REGINA K (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:K
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REGINA
Other - Middle Name:P
Other - Last Name:GILLILAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2906 CAHABA VILLAGE PL
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35243-0890
Mailing Address - Country:US
Mailing Address - Phone:251-622-7514
Mailing Address - Fax:
Practice Address - Street 1:113 RAINBOW INDUSTRIAL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906
Practice Address - Country:US
Practice Address - Phone:256-442-5554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13714207Q00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL149725Medicaid
AL51137968OtherBLUE CROSS BLUE SHIELD
AL149725Medicaid
AL102I250860Medicare PIN