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General NPI Number Information
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NPI Number | 1477446110
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Entity Type | Individual
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Provider Name | ZACH REYNOLDS
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Gender | Male
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 2365 WALL ST SE STE 220
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City | CONYERS
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State | GA
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Zip | 30013-2197
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Country | US
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Telephone | 470-829-6301
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Fax |
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Provider Business Mailing Address
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Address Line | 67 BENDING OAK DR
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City | CHICKAMAUGA
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State | GA
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Zip | 30707-6095
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Country | US
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Telephone | 423-364-3990
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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