Individual
LEAH R REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
4245 JOHNS CREEK PKWY, STE D, SUWANEE, GA 30024-9121
(770) 495-3820
(770) 495-3825
Mailing address
4245 JOHNS CREEK PKWY, STE D, SUWANEE, GA 30024-9121
(770) 495-3820
(770) 495-3825
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
6370
GA
363AS0400X
Surgical Physician Assistant
3344
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003121895D
—
GA
05
—
003121895F
—
GA
05
—
069627
—
AZ
01
—
P00380758
RAILROAD MEDICARE
AZ
Enumeration date
03/25/2006
Last updated
02/01/2017
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