=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295128254
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARMELA REYES FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2015
-----------------------------------------------------
Last Update Date | 03/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3338 PEACHTREE RD NE APT 3602
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30326-1473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-846-1925
-----------------------------------------------------
Fax | 404-846-1925
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3338 PEACHTREE RD NE APT 3602
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30326-1473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-846-1925
-----------------------------------------------------
Fax | 404-846-1925
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN203727
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------