Healthcare Provider Details

I. General information

NPI: 1770530172
Provider Name (Legal Business Name): GEORGE BURTON REED III PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12138 S MAIN ST
TRENTON GA
30752-5151
US

IV. Provider business mailing address

PO BOX 942
TRENTON GA
30752-0942
US

V. Phone/Fax

Practice location:
  • Phone: 706-657-2700
  • Fax: 706-657-7965
Mailing address:
  • Phone: 706-657-2700
  • Fax: 706-657-7965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT001369
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0000000626
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: