Provider Demographics
NPI:1578979449
Name:REED, JAMIE NEAL (EDS, MED, NCSP)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:NEAL
Last Name:REED
Suffix:
Gender:M
Credentials:EDS, MED, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1979 LAKESIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5935
Mailing Address - Country:US
Mailing Address - Phone:866-755-4599
Mailing Address - Fax:
Practice Address - Street 1:1979 LAKESIDE PKWY
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5935
Practice Address - Country:US
Practice Address - Phone:866-755-4599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40404174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist