Provider Demographics
NPI:1316057979
Name:REYNOLDS, ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6982 NASHVILLE ST
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2420
Mailing Address - Country:US
Mailing Address - Phone:706-841-4100
Mailing Address - Fax:
Practice Address - Street 1:1502 HIGHWAY 16 E
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-5202
Practice Address - Country:US
Practice Address - Phone:678-774-0430
Practice Address - Fax:770-775-3410
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3319363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10033117OtherAMERIGROUP
GA100002125AMedicaid
GA319977OtherWELLCARE
GAS59897Medicare UPIN
GA100002125AMedicaid