Healthcare Provider Details

I. General information

NPI: 1528216892
Provider Name (Legal Business Name): MILTON RENARD REED BOCO,BOCPD,LPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 MULKEY RD STE 202
AUSTELL GA
30106-1150
US

IV. Provider business mailing address

1810 MULKEY RD STE 202
AUSTELL GA
30106-1150
US

V. Phone/Fax

Practice location:
  • Phone: 678-738-7380
  • Fax: 678-738-7382
Mailing address:
  • Phone: 678-738-7380
  • Fax: 678-738-7382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number000084
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number000084
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: