Provider Demographics
NPI:1164853792
Name:REID, IMANI
Entity Type:Individual
Prefix:MS
First Name:IMANI
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WATERFORD CT
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4538
Mailing Address - Country:US
Mailing Address - Phone:404-630-7841
Mailing Address - Fax:
Practice Address - Street 1:38 WATERFORD CT
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4538
Practice Address - Country:US
Practice Address - Phone:404-630-7841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-08
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant