Provider Demographics
NPI:1114653391
Name:LAMAR-REYNOLDS, CORBIN JAIDEN
Entity Type:Individual
Prefix:MR
First Name:CORBIN
Middle Name:JAIDEN
Last Name:LAMAR-REYNOLDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 MARQUIS WAY
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-4140
Mailing Address - Country:US
Mailing Address - Phone:478-262-8531
Mailing Address - Fax:
Practice Address - Street 1:1011 MARQUIS WAY
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-4140
Practice Address - Country:US
Practice Address - Phone:478-262-8531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory