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General NPI Number Information
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NPI Number | 1427411347
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Entity Type | Organization
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Legal Business Name | CALVIN L. REID GERIATRIC SERVICES, LLC
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 636 WESTWOOD RD
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City | DOTHAN
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State | AL
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Zip | 36303-2928
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Country | US
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Telephone | 334-793-5074
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Fax | 334-793-6460
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Provider Business Mailing Address
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Address Line | 636 WESTWOOD RD
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City | DOTHAN
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State | AL
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Zip | 36303-2928
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Country | US
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Telephone | 334-793-5074
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Fax | 334-793-6460
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CALVIN L REID
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Credential | M.D.
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Telephone | 334-793-5074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 9359
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License Number State | AL
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