MEDICARE: DENISE S REYNOLDS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN120844	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285620914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE S REYNOLDS NP

Provider Business Mailing Address
First Line	:	5095 PEACHTREE PKWY
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30092-2524
Country	:	US
Telephone Number	:	770-209-9299
Fax Number	:

Provider Business Practice Location Address
First Line	:	5095 PEACHTREE PKWY
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30092-2524
Country	:	US
Telephone Number	:	770-209-9299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	02/14/2020

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