Individual
NICHOLAS PETER KEVIN REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BSRN
Contact information
Practice address
2075 CHANNING DR, CONYERS, GA 30094-4164
(646) 515-6037
Mailing address
2075 CHANNING DR, CONYERS, GA 30094-4164
(646) 515-6037
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
800391
NY
163WC0200X
Critical Care Medicine Registered Nurse
Primary
RN278989
GA
Other
Enumeration date
08/09/2024
Last updated
08/09/2024
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