Provider Demographics
NPI:1699961870
Name:REYNOLDS, STACY
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:
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 1:2175 WALLACE RD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-7758
Mailing Address - Country:US
Mailing Address - Phone:404-405-7260
Mailing Address - Fax:
Practice Address - Street 1:1458 CHURCH ST STE B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1672
Practice Address - Country:US
Practice Address - Phone:404-508-2000
Practice Address - Fax:404-508-5012
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058917207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology