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General NPI Number Information
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NPI Number | 1467097592
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Entity Type | Individual
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Provider Name | AMBER EDWINA REID LPN
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Gender | Female
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 11/13/2019
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Provider Practice Location Address
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Address Line | 2109 FAIRBURN RD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1037
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Country | US
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Telephone | 770-726-7958
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Fax |
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Provider Business Mailing Address
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Address Line | 150 BEAR RUN CT
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City | PALMETTO
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State | GA
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Zip | 30268-1817
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Country | US
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Telephone | 413-313-9043
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN098201
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License Number State | GA
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