1124061585 NPI number — JOSEPH C REYNOLDS II P.A

Table of content: JOSEPH C REYNOLDS II P.A (NPI 1124061585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124061585 NPI number — JOSEPH C REYNOLDS II P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYNOLDS
Provider First Name:
JOSEPH
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
P.A
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124061585
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7820 HICKORY FLAT HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSTOCK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30188-2099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-504-5678
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 TOWNPARK LN NW
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE TOWNPARK COMPREHENSIVE MEDICAL CENTER
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144-5579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-514-5401
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  007884-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 47000 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)