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NPI Code Detail

MEDICARE: CHANTIA REYNOLDS AGACNP

MEDICARE: CHANTIA REYNOLDS AGACNP
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
1363L00000XNurse PractitionerNP237254GA

General Provider Information

NPI Number : 1841156577
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANTIA REYNOLDS AGACNP
Provider Business Mailing Address
First Line : 4660 DERRICK RD APT 5108
Second Line :
City : ATLANTA
State : GA
Zip : 30349-1956
Country : US
Telephone Number : 404-626-3330
Fax Number :
Provider Business Practice Location Address
First Line : 4770 WHITE PLAINS RD
Second Line :
City : BRONX
State : NY
Zip : 10470-1136
Country : US
Telephone Number : 718-931-9700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2025
Last Update Date : 12/26/2025

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