Provider Demographics
NPI:1275253247
Name:REED, TIA RENE'E (DC)
Entity Type:Individual
Prefix:DR
First Name:TIA
Middle Name:RENE'E
Last Name:REED
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 MEDLIN ST SE APT D7
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4349
Mailing Address - Country:US
Mailing Address - Phone:407-715-1109
Mailing Address - Fax:
Practice Address - Street 1:1624 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-2824
Practice Address - Country:US
Practice Address - Phone:404-592-0319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor