Individual
TIASHYANA REID
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30046-8444
(678) 209-2394
Mailing address
2890 VALLEY RIDGE DR, DECATUR, GA 30032-5765
(203) 290-9462
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN097219
GA
Other
Enumeration date
01/05/2021
Last updated
01/05/2021
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