Search › Georgia › 363LF0000X
Ivan Regalado Rodriguez
NPI 1639871866 · on the registry since 2023 · sole proprietor
Practice
- Address
- 4614 Wisteria Ln
Fortson, GA 31808 - Phone
- (770) 882-1728
Registry record
- Primary taxonomy
- 363LF0000X
363LF0000X
- Also registered as
- 363LF0000X
- Licence states on file
- FL, GA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2025-10-12
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Georgia