Provider Demographics
NPI:1205842374
Name:REYNOLDS, REUBEAN ALVIS (MD)
Entity Type:Individual
Prefix:DR
First Name:REUBEAN
Middle Name:ALVIS
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
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 962380
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-6921
Mailing Address - Country:US
Mailing Address - Phone:770-996-1200
Mailing Address - Fax:770-907-7492
Practice Address - Street 1:81 UPPER RIVERDALE RD SW
Practice Address - Street 2:SUITE 210
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2634
Practice Address - Country:US
Practice Address - Phone:770-996-1200
Practice Address - Fax:770-907-7492
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025822207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000607945AMedicaid
GA000607945AMedicaid
GA16BDDMFMedicare ID - Type Unspecified