Healthcare Provider Details

I. General information

NPI: 1720713597
Provider Name (Legal Business Name): EDNA A REID NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 04/09/2023
Certification Date: 04/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 ROSWELL RD APT 638
MARIETTA GA
30062-3657
US

IV. Provider business mailing address

1675 ROSWELL RD APT 638
MARIETTA GA
30062-3657
US

V. Phone/Fax

Practice location:
  • Phone: 470-244-9731
  • Fax:
Mailing address:
  • Phone: 470-244-9731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF07220753
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN26453
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN26453
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: