Provider Demographics
NPI:1932880689
Name:MCGOVERN, REGAN ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:ELIZABETH
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MOUNT VERNON CIR
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5436
Mailing Address - Country:US
Mailing Address - Phone:678-480-2135
Mailing Address - Fax:
Practice Address - Street 1:1829 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5728
Practice Address - Country:US
Practice Address - Phone:404-292-8335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant