Individual
DR. MICHAEL B REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
605 S ENOTA DR NE, GAINESVILLE, GA 30501-2437
(770) 538-0208
(770) 538-0556
Mailing address
605 ENOTA DR, GAINESVILLE, GA 30501-2437
(770) 538-0208
(770) 538-0556
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
046224
GA
207NS0135X
Procedural Dermatology Physician
046224
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007735230
AETNA
GA
05
—
000814767A
—
GA
01
—
070015990
RAILROAD MEDICARE
GA
01
—
1487604021
BCBS
GA
01
—
CH9982
RAILROAD MEDICARE
GA
Enumeration date
05/12/2006
Last updated
09/30/2013
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