Individual
JOHNNIE WYATTE REID
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4727 ROSECROFT ST, VIRGINIA BEACH, VA 23464-3029
(757) 816-0622
(757) 467-5257
Mailing address
4727 ROSECROFT ST, VIRGINIA BEACH, VA 23464-3029
(757) 816-0622
(757) 467-5257
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
420
VA
Other
Enumeration date
04/28/2016
Last updated
07/21/2022
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