Provider Demographics
NPI:1215449616
Name:RHODES, REAGIN FARLEY (PA-C)
Entity type:Individual
Prefix:MS
First Name:REAGIN
Middle Name:FARLEY
Last Name:RHODES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 MOUNTAIN CREEK RD APT B25
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-4506
Mailing Address - Country:US
Mailing Address - Phone:205-807-7553
Mailing Address - Fax:
Practice Address - Street 1:3917 GEORGETOWN RD NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-1806
Practice Address - Country:US
Practice Address - Phone:423-813-3830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TN3312363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant