MEDICARE: WHITNEY L REYNOLDS P.A.

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	363AM0700X	Medical Physician Assistant	1284	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4167841	OTHER	TN	BCBST

General Provider Information

NPI Number	:	1801959259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY L REYNOLDS P.A.

Provider Business Mailing Address
First Line	:	1215 21ST AVE S
Second Line	:	MCE 5TH FLOOR, SOUTH TOWER, SUITE 5209
City	:	NASHVILLE
State	:	TN
Zip	:	37232-0014
Country	:	US
Telephone Number	:	615-322-2318
Fax Number	:	615-936-1711

Provider Business Practice Location Address
First Line	:	1215 21ST AVE S
Second Line	:	MCE 5TH FLOOR, SOUTH TOWER, SUITE 5209
City	:	NASHVILLE
State	:	TN
Zip	:	37232-0014
Country	:	US
Telephone Number	:	615-322-2318
Fax Number	:	615-936-1711

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	01/30/2009

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Directions to “ WHITNEY L REYNOLDS P.A.” Practice Location

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