Provider Demographics
NPI:1003815580
Name:REYNOLDS, THOMAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2158 NORTHGATE PARK LN
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-6957
Mailing Address - Country:US
Mailing Address - Phone:423-870-4900
Mailing Address - Fax:423-870-5889
Practice Address - Street 1:2158 NORTHGATE PARK LN
Practice Address - Street 2:SUITE 302
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-6957
Practice Address - Country:US
Practice Address - Phone:423-870-4900
Practice Address - Fax:423-870-5889
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD016274207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180029644OtherRR MEDICARE
TN3711088Medicaid
TN3031931Medicaid
SC1187690001OtherDMERC GROUP SUPPLIER NUMB
3069497OtherBLUE CROSS
62-1701871OtherTAX ID
TNA99560Medicare UPIN
TN3711088Medicaid
TN3031931Medicaid