Individual
GREGORY REID
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4526
(770) 719-7000
Mailing address
225 HAPPY HOLLOW RD, HAMPTON, GA 30228-3011
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XKP544A78869
BLUE CROSS BLUE SHIELD
GA
Enumeration date
08/25/2015
Last updated
08/25/2015
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