Provider Demographics
NPI:1740218890
Name:PHILLIPS, REGINA K (MD)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:K
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REGINA
Other - Middle Name:P
Other - Last Name:GILLILAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10680 MEDLOCK BRIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8420
Mailing Address - Country:US
Mailing Address - Phone:470-292-3820
Mailing Address - Fax:
Practice Address - Street 1:10680 MEDLOCK BRIDGE RD STE 204
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-8420
Practice Address - Country:US
Practice Address - Phone:470-292-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13714208100000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL149725Medicaid
AL51137968OtherBLUE CROSS BLUE SHIELD
AL149725Medicaid
AL102I250860Medicare PIN