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NPI Code Detail

MEDICARE: REAGAN R. DUNNAHOO PA

MEDICARE: REAGAN R. DUNNAHOO PA
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
1363AM0700XMedical Physician Assistant96-PA02NM

Other Identifiers

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

General Provider Information

NPI Number : 1568455616
Entity Type Code : Individual
Provider Name (Legal Business Name) : REAGAN R. DUNNAHOO PA
Provider Business Mailing Address
First Line : PO BOX 5719
Second Line :
City : ATHENS
State : GA
Zip : 30604-5719
Country : US
Telephone Number : 706-354-5770
Fax Number : 706-354-5769
Provider Business Practice Location Address
First Line : 2450 S TELSHOR BLVD
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-5069
Country : US
Telephone Number : 706-354-5770
Fax Number : 706-354-5769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 07/27/2011

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Directions to “ REAGAN R. DUNNAHOO PA” Practice Location

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