Individual
ELIZABETH REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1502 HIGHWAY 16 E, JACKSON, GA 30233-5202
(678) 774-0430
(770) 775-3410
Mailing address
6982 NASHVILLE ST, RINGGOLD, GA 30736-2420
(706) 841-4100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3319
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002125A
—
GA
01
—
10033117
AMERIGROUP
GA
01
—
319977
WELLCARE
GA
Enumeration date
08/30/2006
Last updated
01/03/2025
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