Provider Demographics
NPI:1013613785
Name:AVANT, REGINA L
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:L
Last Name:AVANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-1185
Mailing Address - Country:US
Mailing Address - Phone:404-246-5671
Mailing Address - Fax:
Practice Address - Street 1:45 PARTRIDGE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-1185
Practice Address - Country:US
Practice Address - Phone:404-246-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver