MEDICARE: SUSAN SHAW REINES MD

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	208000000X	Pediatrics Physician	032809	GA
2	174400000X	Specialist	32809	GA

General Provider Information

NPI Number	:	1770547994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN SHAW REINES MD

Provider Business Mailing Address
First Line	:	3495 PIEDMONT ROAD NE
Second Line	:	NINE PIEDMONT CENTER
City	:	ATLANTA
State	:	GA
Zip	:	30305
Country	:	US
Telephone Number	:	404-364-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	8011 MALL PARKWAY
Second Line	:	KAISER PERMANENTE STONECREST MEDICAL CENTER
City	:	LITHONIA
State	:	GA
Zip	:	30038
Country	:	US
Telephone Number	:	678-323-7510
Fax Number	:	678-323-7522

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	04/12/2022

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