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NPI Code Detail

MEDICARE: WENDIE BRANNEN REYNOLDS LCSW, ACSW, MA

MEDICARE: WENDIE BRANNEN REYNOLDS LCSW, ACSW, MA
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
11041C0700XClinical Social WorkerCSW002636GA

General Provider Information

NPI Number : 1982857991
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDIE BRANNEN REYNOLDS LCSW, ACSW, MA
Provider Business Mailing Address
First Line : 179 PIERCE AVE
Second Line :
City : MACON
State : GA
Zip : 31204-2821
Country : US
Telephone Number : 478-742-1464
Fax Number : 478-742-1883
Provider Business Practice Location Address
First Line : 179 PIERCE AVE
Second Line :
City : MACON
State : GA
Zip : 31204-2821
Country : US
Telephone Number : 478-742-1464
Fax Number : 478-742-1883
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2008
Last Update Date : 02/25/2016

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