Healthcare Provider Details

I. General information

NPI: 1972710853
Provider Name (Legal Business Name): DR. ALESIA A. REYNOLDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3091 MAPLE DR NE SUITE 208
ATLANTA GA
30305-2610
US

IV. Provider business mailing address

PO BOX 550747
ATLANTA GA
30355-3247
US

V. Phone/Fax

Practice location:
  • Phone: 404-477-1797
  • Fax: 404-477-1897
Mailing address:
  • Phone: 404-477-1797
  • Fax: 404-477-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number005937
License Number StateGA

VIII. Authorized Official

Name: DR. ALESIA A REYNOLDS
Title or Position: OWNER DOCTOR
Credential:
Phone: 404-477-1797