Healthcare Provider Details

I. General information

NPI: 1770564734
Provider Name (Legal Business Name): MICHELLE W REED M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 NORMANDIE DR SUITE 108
MONTGOMERY AL
36111-2732
US

IV. Provider business mailing address

2055 NORMANDIE DR SUITE 108
MONTGOMERY AL
36111-2732
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-4624
  • Fax: 334-280-3628
Mailing address:
  • Phone: 334-269-6337
  • Fax: 334-834-0657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number15782
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME91309
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD 15782
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: