MEDICARE: DEIRDRE REID FNP-BC

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	APRN-NP299673	GA

General Provider Information

NPI Number	:	1316738578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIRDRE REID FNP-BC

Provider Business Mailing Address
First Line	:	3675 J DEWEY GRAY CIR # 300
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-1868
Country	:	US
Telephone Number	:	855-863-9595
Fax Number	:

Provider Business Practice Location Address
First Line	:	3675 J DEWEY GRAY CIR
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-1868
Country	:	US
Telephone Number	:	855-863-9595
Fax Number	:

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

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	12/08/2025

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