Provider Demographics
NPI:1194148502
Name:REID, JULIA BEDINGFIELD (PHARMD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:BEDINGFIELD
Last Name:REID
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 NORTHSIDE CHEROKEE BLVD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8015
Mailing Address - Country:US
Mailing Address - Phone:770-721-9100
Mailing Address - Fax:770-721-9101
Practice Address - Street 1:450 NORTHSIDE CHEROKEE BLVD STE T20
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115
Practice Address - Country:US
Practice Address - Phone:770-721-9100
Practice Address - Fax:770-721-9101
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist