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General NPI Number Information
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NPI Number | 1770697609
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Entity Type | Individual
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Provider Name | NANCY ELLEN REID PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 1634 WHITE CIRCLE, SUITE 101
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City | MARIETTA
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State | GA
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Zip | 30066
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Country | US
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Telephone | 770-325-7294
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Fax | 770-325-7294
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Provider Business Mailing Address
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Address Line | 5605 COPPER CREEK PASS
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City | CUMMING
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State | GA
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Zip | 30040
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Country | US
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Telephone | 678-451-4609
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Fax | 770-325-7294
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 4677
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License Number State | GA
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