Provider Demographics
NPI:1568961456
Name:REYNOLDS, TAMEKA M (NP)
Entity Type:Individual
Prefix:
First Name:TAMEKA
Middle Name:M
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TAMEKA
Other - Middle Name:
Other - Last Name:RUCKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1711 BUENA VISTA RD STE 5
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-6143
Mailing Address - Country:US
Mailing Address - Phone:706-571-3300
Mailing Address - Fax:706-571-3320
Practice Address - Street 1:1711 BUENA VISTA RD STE 5
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-6143
Practice Address - Country:US
Practice Address - Phone:706-571-3300
Practice Address - Fax:706-571-3320
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-165183363L00000X
GARN203695363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner