Provider Demographics
NPI:1619165388
Name:REID, CARRIE ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:ANN
Last Name:REID
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 TIPTON DR
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1603
Mailing Address - Country:US
Mailing Address - Phone:706-864-4012
Mailing Address - Fax:706-864-4029
Practice Address - Street 1:59 TIPTON DR
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1603
Practice Address - Country:US
Practice Address - Phone:706-864-4012
Practice Address - Fax:706-864-4029
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005195363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA005195OtherSTATE LICENSE