Provider Demographics
NPI:1093047474
Name:REINECKE, KIRBY BROWN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KIRBY
Middle Name:BROWN
Last Name:REINECKE
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Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:120 OAKSIDE CT
Mailing Address - Street 2:SUITE H
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2471
Mailing Address - Country:US
Mailing Address - Phone:678-880-8770
Mailing Address - Fax:770-213-4418
Practice Address - Street 1:120 OAKSIDE CT
Practice Address - Street 2:SUITE H
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2471
Practice Address - Country:US
Practice Address - Phone:678-880-8770
Practice Address - Fax:770-213-4418
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA5775363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical