Provider Demographics
NPI:1972710853
Name:DR. ALESIA A. REYNOLDS
Entity type:Organization
Organization Name:DR. ALESIA A. REYNOLDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALESIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-477-1797
Mailing Address - Street 1:PO BOX 550747
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30355-3247
Mailing Address - Country:US
Mailing Address - Phone:404-477-1797
Mailing Address - Fax:404-477-1897
Practice Address - Street 1:3091 MAPLE DR NE
Practice Address - Street 2:SUITE 208
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2610
Practice Address - Country:US
Practice Address - Phone:404-477-1797
Practice Address - Fax:404-477-1897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005937111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU76310Medicare UPIN
GA35ZCFQWMedicare ID - Type Unspecified