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NPI Code Detail

MEDICARE: ELIZABETH JEAN REARDON N.P.

MEDICARE: ELIZABETH JEAN REARDON N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAPRN-NP077989GA

General Provider Information

NPI Number : 1174765853
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH JEAN REARDON N.P.
Provider Business Mailing Address
First Line : 1816 EAGLE DR STE 200-B
Second Line :
City : WOODSTOCK
State : GA
Zip : 30189-8274
Country : US
Telephone Number : 404-255-5956
Fax Number : 770-575-3504
Provider Business Practice Location Address
First Line : 1816 EAGLE DR STE 200-B
Second Line :
City : WOODSTOCK
State : GA
Zip : 30189-8274
Country : US
Telephone Number : 404-255-5956
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2009
Last Update Date : 10/15/2025

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