Provider Demographics
NPI:1811398001
Name:REED, LORI GORDON
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:GORDON
Last Name:REED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:MICHELLE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:400 TOWER RD NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-9411
Mailing Address - Country:US
Mailing Address - Phone:770-514-7550
Mailing Address - Fax:770-514-1390
Practice Address - Street 1:400 TOWER RD NE
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9411
Practice Address - Country:US
Practice Address - Phone:770-514-7550
Practice Address - Fax:770-514-1390
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily