Individual
MR. EDWARD J. REILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1005 W TAYLOR ST, GRIFFIN, GA 30223-2607
(770) 227-0333
Mailing address
2473 STATE ROUTE 4, FORT EDWARD, NY 12828-3417
(770) 375-9204
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004794
GA
363A00000X
Physician Assistant
05269-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
939150895A
—
GA
05
—
939150895B
—
GA
Enumeration date
07/18/2006
Last updated
12/14/2020
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