Provider Demographics
NPI:1366985335
Name:MCBRIDE, REGINA
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:MCBRIDE
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 1:4250 PALM SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6521
Mailing Address - Country:US
Mailing Address - Phone:404-362-7965
Mailing Address - Fax:
Practice Address - Street 1:4250 PALM SPRINGS DR
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6521
Practice Address - Country:US
Practice Address - Phone:404-362-7965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care