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IVAN REGALADO RODRIGUEZ
NPI 1639871866
Nurse Practitioner - Family in Fortson, GA

Active since March 21, 2023
4614 WISTERIA LN, FORTSON, GA 31808(770) 882-1728 Get Directions Write a Review

NPPES record last updated: October 12, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Oct 12, 2025, Jul 21, 2023, Mar 25, 2023 (3 updates tracked since 2023).

About Ivan Regalado Rodriguez NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IVAN REGALADO RODRIGUEZ (NPI 1639871866) is an individual family provider in Fortson, Georgia, licensed in Georgia (RN291972) and active in the NPI registry since March 2023.

NPPES Registry Identity

NPI1639871866
Entity TypeIndividualMale
Primary Taxonomy363LF0000X
Provider Legal NameIVAN REGALADO RODRIGUEZ
Location Address4614 WISTERIA LNFortson, GA 31808-6986
Mailing Address4614 Wisteria LnFortson, GA 31808-6986 · (770) 882-1728
Phone(770) 882-1728
Sole ProprietorYes
Enumeration DateMarch 21, 2023
Last NPPES UpdateOctober 12, 20253 updates tracked since enumeration
NPPES CertifiedOctober 12, 2025
✔ NPI 1639871866 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
Licenses✔ Licensed in GA · RN291972✔ Licensed in FL · APRN11025390
4614 WISTERIA LN, Fortson, GA 31808
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Other Names 1

Former Name (1)Ivan Regalado

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ivan Regalado Rodriguez's NPI number?

The NPI number for Ivan Regalado Rodriguez is 1639871866. It was assigned to this individual provider in the NPPES registry on March 21, 2023. The provider is also known as Ivan Regalado.

Where is Ivan Regalado Rodriguez located?

Ivan Regalado Rodriguez practices at 4614 Wisteria Ln, Fortson, GA 31808. The listed phone number is (770) 882-1728.

What is Ivan Regalado Rodriguez's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Ivan Regalado Rodriguez was last updated on October 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.