Provider Demographics
NPI:1073330627
Name:REED, NATALIE JACKSON (DPT)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:JACKSON
Last Name:REED
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:RAE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3812 WESTSHORE DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6444
Mailing Address - Country:US
Mailing Address - Phone:678-687-7290
Mailing Address - Fax:
Practice Address - Street 1:540 LAKE CENTER PKWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-7727
Practice Address - Country:US
Practice Address - Phone:770-205-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017412208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation