Provider Demographics
NPI:1154358208
Name:REED, DEBORAH A (RN-CNS/PMH)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:REED
Suffix:
Gender:F
Credentials:RN-CNS/PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1576
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30085-1576
Mailing Address - Country:US
Mailing Address - Phone:770-778-1349
Mailing Address - Fax:678-348-7291
Practice Address - Street 1:10 WOLVERTON CT
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-2514
Practice Address - Country:US
Practice Address - Phone:770-778-1349
Practice Address - Fax:678-348-7291
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA102945364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA83-01926OtherEVERCARE
GA000958284BMedicaid
GAP00138603OtherRR MEDICARE
GA50BBHLQMedicare ID - Type Unspecified
GA000958284BMedicaid