Provider Demographics
NPI:1467097592
Name:REID, AMBER EDWINA (LPN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:EDWINA
Last Name:REID
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BEAR RUN CT
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-1817
Mailing Address - Country:US
Mailing Address - Phone:413-313-9043
Mailing Address - Fax:
Practice Address - Street 1:2109 FAIRBURN RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1037
Practice Address - Country:US
Practice Address - Phone:770-726-7958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN098201164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse