Healthcare Provider Details

I. General information

NPI: 1982828828
Provider Name (Legal Business Name): JOHN ERNEST REED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 HOLCOMB CT
BOGART GA
30622-2391
US

IV. Provider business mailing address

1071 HOLCOMB CT
BOGART GA
30622-2391
US

V. Phone/Fax

Practice location:
  • Phone: 770-417-1234
  • Fax: 251-758-3019
Mailing address:
  • Phone: 770-417-1234
  • Fax: 251-758-3019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number035506
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: