Healthcare Provider Details

I. General information

NPI: 1245293570
Provider Name (Legal Business Name): DAVID A REEDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 AUSTELL ROAD
AUSTELL GA
30106
US

IV. Provider business mailing address

PO BOX 813683
SMYRNA GA
30081-8683
US

V. Phone/Fax

Practice location:
  • Phone: 770-732-3649
  • Fax: 770-732-3648
Mailing address:
  • Phone: 404-803-2494
  • Fax: 770-438-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number028633
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: