Provider Demographics
NPI:1285624023
Name:REGAN, SALLY WEBB (MD)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:WEBB
Last Name:REGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4300 N ACCESS RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-3812
Mailing Address - Country:US
Mailing Address - Phone:423-826-1276
Mailing Address - Fax:423-826-1290
Practice Address - Street 1:1304 W BOBO NEWSOM HWY
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4710
Practice Address - Country:US
Practice Address - Phone:843-339-4790
Practice Address - Fax:843-339-4791
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC186342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN39869Medicaid
SCAA8176A653Medicare PIN