Provider Demographics
NPI:1861435349
Name:REYNOLDS, ANNALISE C (MD)
Entity type:Individual
Prefix:DR
First Name:ANNALISE
Middle Name:C
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNALISE
Other - Middle Name:B
Other - Last Name:CAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 PROFESSIONAL CT SE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-7020
Mailing Address - Country:US
Mailing Address - Phone:706-625-5900
Mailing Address - Fax:706-625-6519
Practice Address - Street 1:204 PROFESSIONAL CT SE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-7020
Practice Address - Country:US
Practice Address - Phone:706-625-5900
Practice Address - Fax:706-625-6519
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA54069208000000X
GA054069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA599211308BMedicaid
GA599211308AMedicaid
GA599211308AMedicaid
GA37BBHBCMedicare ID - Type Unspecified