Provider Demographics
NPI:1346058518
Name:REYNOLDS, DONNITA A
Entity type:Individual
Prefix:
First Name:DONNITA
Middle Name:A
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5468 HIRAM LITHIA SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-3512
Mailing Address - Country:US
Mailing Address - Phone:470-713-4054
Mailing Address - Fax:770-694-6277
Practice Address - Street 1:5468 HIRAM LITHIA SPRINGS RD
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-3512
Practice Address - Country:US
Practice Address - Phone:470-713-4054
Practice Address - Fax:770-694-6277
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376K00000X, 390200000X
GA246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No376K00000XNursing Service Related ProvidersNurse's Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program