Healthcare Provider Details

I. General information

NPI: 1114922374
Provider Name (Legal Business Name): JOSEPH K REID P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 BOONES CREEK ROAD
GRAY TN
37615-1417
US

IV. Provider business mailing address

2244 BOONES CREEK ROAD
GRAY TN
37615-1417
US

V. Phone/Fax

Practice location:
  • Phone: 423-753-4000
  • Fax: 423-753-4004
Mailing address:
  • Phone: 423-753-4000
  • Fax: 423-753-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0844
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: