MEDICARE: MRS. CANDACE RENEE WOOTEN-REED PA-C

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
1	363AM0700X	Medical Physician Assistant	0010-03360	NC
2	363AM0700X	Medical Physician Assistant	5601005386	MI
3	363AM0700X	Medical Physician Assistant	007386	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750529764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CANDACE RENEE WOOTEN-REED PA-C

Provider Business Mailing Address
First Line	:	2428 MUIRFIELD PL
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30337-1635
Country	:	US
Telephone Number	:	404-446-3870
Fax Number	:	404-446-3875

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE STE 1700
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2262
Country	:	US
Telephone Number	:	404-881-9727
Fax Number	:	704-801-2001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2009
Last Update Date	:	05/18/2022

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Directions to “ MRS. CANDACE RENEE WOOTEN-REED PA-C” Practice Location

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