Healthcare Provider Details

I. General information

NPI: 1063504710
Provider Name (Legal Business Name): CHERYL REINHARDT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 NEW CALHOUN HWY NE
ROME GA
30161-8253
US

IV. Provider business mailing address

PO BOX 975
SHANNON GA
30172-0975
US

V. Phone/Fax

Practice location:
  • Phone: 706-295-1184
  • Fax: 706-236-1919
Mailing address:
  • Phone: 706-295-1184
  • Fax: 706-236-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25079
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: