Provider Demographics
NPI:1871784777
Name:FIELDS, REGINA JELLICORSE (MD)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:JELLICORSE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:JELLICORSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 W PRICE RD
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-4524
Mailing Address - Country:US
Mailing Address - Phone:865-475-6161
Mailing Address - Fax:865-475-9857
Practice Address - Street 1:150 W PRICE RD
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725
Practice Address - Country:US
Practice Address - Phone:865-475-6161
Practice Address - Fax:865-475-9857
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45159207P00000X, 208M00000X
TNMD45159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520666Medicaid
TN1520666Medicaid