Provider Demographics
NPI:1477446110
Name:REYNOLDS, ZACH
Entity type:Individual
Prefix:
First Name:ZACH
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 BENDING OAK DR
Mailing Address - Street 2:
Mailing Address - City:CHICKAMAUGA
Mailing Address - State:GA
Mailing Address - Zip Code:30707-6095
Mailing Address - Country:US
Mailing Address - Phone:423-364-3990
Mailing Address - Fax:
Practice Address - Street 1:2365 WALL ST SE STE 220
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2197
Practice Address - Country:US
Practice Address - Phone:470-829-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health