Healthcare Provider Details

I. General information

NPI: 1396521910
Provider Name (Legal Business Name): MICHELLE SUZANNE REED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4865 LAVISTA RD STE A
TUCKER GA
30084-4436
US

IV. Provider business mailing address

PO BOX 117598
ATLANTA GA
30368-7598
US

V. Phone/Fax

Practice location:
  • Phone: 770-466-5902
  • Fax: 678-666-1300
Mailing address:
  • Phone: 770-442-1911
  • Fax: 770-442-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN275641
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: