Basic Information
| Provider Information | |||||||||
| NPI: | 1053697714 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALLY W REGAN MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5938 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374060938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238261276 | ||||||||
| FaxNumber: | 4238261290 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297069769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035819413 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2011 | ||||||||
| LastUpdateDate: | 01/11/2012 | ||||||||
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| AuthorizedOfficialLastName: | REGAN | ||||||||
| AuthorizedOfficialFirstName: | SALLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4238261276 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.