Provider Demographics
NPI:1114922374
Name:REID, JOSEPH K (PA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:K
Last Name:REID
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 BOONES CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-1417
Mailing Address - Country:US
Mailing Address - Phone:423-753-4000
Mailing Address - Fax:423-753-4004
Practice Address - Street 1:2244 BOONES CREEK ROAD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-1417
Practice Address - Country:US
Practice Address - Phone:423-753-4000
Practice Address - Fax:423-753-4004
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0844363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP36096Medicare UPIN
TN36691612Medicare PIN