Provider Demographics
NPI:1528216892
Name:REED, MILTON RENARD (BOCO,BOCPD,LPO)
Entity Type:Individual
Prefix:MR
First Name:MILTON
Middle Name:RENARD
Last Name:REED
Suffix:
Gender:M
Credentials:BOCO,BOCPD,LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 MULKEY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1150
Mailing Address - Country:US
Mailing Address - Phone:678-738-7380
Mailing Address - Fax:678-738-7382
Practice Address - Street 1:1810 MULKEY RD STE 202
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1150
Practice Address - Country:US
Practice Address - Phone:678-738-7380
Practice Address - Fax:678-738-7382
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000084224P00000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000084OtherGEORGIA LICENSED ORTHOTIST PROSTHETIST