Provider Demographics
NPI:1639374283
Name:REINGOLD, JASON SETH (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:SETH
Last Name:REINGOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3943 DAHLWINY CT
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-1153
Mailing Address - Country:US
Mailing Address - Phone:404-946-8797
Mailing Address - Fax:404-595-4650
Practice Address - Street 1:11680 GREAT OAKS WAY STE 170
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-2483
Practice Address - Country:US
Practice Address - Phone:404-900-9970
Practice Address - Fax:770-755-5865
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA064255207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
202I06OtherMEDICARE
GA003118775CMedicaid
GA003118762AMedicaid
GA003118775BMedicaid
GA003118762BMedicaid
GA202I068246Medicare PIN