MEDICARE: CARMELA REYES FNP

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	RN203727	GA

General Provider Information

NPI Number	:	1295128254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMELA REYES FNP

Provider Business Mailing Address
First Line	:	3338 PEACHTREE RD NE
Second Line	:	APT 3602
City	:	ATLANTA
State	:	GA
Zip	:	30326-1473
Country	:	US
Telephone Number	:	404-846-1925
Fax Number	:	404-846-1925

Provider Business Practice Location Address
First Line	:	3338 PEACHTREE RD NE
Second Line	:	APT 3602
City	:	ATLANTA
State	:	GA
Zip	:	30326-1473
Country	:	US
Telephone Number	:	404-846-1925
Fax Number	:	404-846-1925

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

Provider Enumeration Date	:	03/13/2015
Last Update Date	:	03/13/2015

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