Provider Demographics
NPI:1922064336
Name:DANDY, REGINA BUCKLEY (DO)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:BUCKLEY
Last Name:DANDY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:L
Other - Last Name:BUCKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 15849
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2549
Mailing Address - Country:US
Mailing Address - Phone:912-527-5301
Mailing Address - Fax:912-756-4740
Practice Address - Street 1:89 INTERCHANGE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7661
Practice Address - Country:US
Practice Address - Phone:912-527-5301
Practice Address - Fax:912-756-4740
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA046401246DMedicaid
GA404141OtherWELLCARE
GA046401246AMedicaid
GA10069519OtherAMERIGROUP
GAGRP3905OtherGA MEDICARE GROUP ID
GAP00394151OtherRR MEDICARE
GA046401246BMedicaid
GACH5121OtherRR MEDICARE GROUP ID
SCG57286Medicaid
GA52206024-001OtherBCBS GA
GA046401246CMedicaid
GAI57387Medicare UPIN
GA404141OtherWELLCARE