=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104840321
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULA REYNOLDS FP/WHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 07/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 19TH ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31901-1528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-322-7884
-----------------------------------------------------
Fax | 706-660-2142
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9247
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31908-9247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-322-7884
-----------------------------------------------------
Fax | 706-243-4356
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | R109014
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------