Provider Demographics
NPI:1073549846
Name:REYNOLDS, ALESIA A (DC)
Entity Type:Individual
Prefix:DR
First Name:ALESIA
Middle Name:A
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550747
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30355-3247
Mailing Address - Country:US
Mailing Address - Phone:404-477-1797
Mailing Address - Fax:404-477-1897
Practice Address - Street 1:3091 MAPLE DR NE
Practice Address - Street 2:SUITE 208
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2610
Practice Address - Country:US
Practice Address - Phone:404-477-1797
Practice Address - Fax:404-477-1897
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005937111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCFQWMedicare ID - Type Unspecified
GAU76310Medicare UPIN