Healthcare Provider Details

I. General information

NPI: 1356130215
Provider Name (Legal Business Name): REAGAN SEXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8335 OFFICE PARK DR STE A
DOUGLASVILLE GA
30134-6937
US

IV. Provider business mailing address

3384 MASON CREEK RD
WINSTON GA
30187-1563
US

V. Phone/Fax

Practice location:
  • Phone: 678-324-0476
  • Fax:
Mailing address:
  • Phone: 678-231-6736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: