Provider Demographics
NPI:1184134967
Name:REGAN, BRENNAN ADARE (PA-C)
Entity type:Individual
Prefix:MS
First Name:BRENNAN
Middle Name:ADARE
Last Name:REGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 NORTHRIDGE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3314
Mailing Address - Country:US
Mailing Address - Phone:803-736-3277
Mailing Address - Fax:
Practice Address - Street 1:145 PARK CENTRAL DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6469
Practice Address - Country:US
Practice Address - Phone:803-736-3277
Practice Address - Fax:803-408-8698
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601012206363A00000X
SC5309363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant