Provider Demographics
NPI:1386989309
Name:REED, ZACHARY WILLIAM
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:WILLIAM
Last Name:REED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 FLOSSMOOR CIR
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38558-7700
Mailing Address - Country:US
Mailing Address - Phone:931-200-1828
Mailing Address - Fax:
Practice Address - Street 1:122 FLOSSMOOR CIR
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38558-7700
Practice Address - Country:US
Practice Address - Phone:931-200-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2012-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN092888479172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver