Provider Demographics
NPI:1659130300
Name:REAM, BO SKYDON
Entity Type:Individual
Prefix:
First Name:BO
Middle Name:SKYDON
Last Name:REAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 MALL OF GEORGIA BLVD, BUFORD, GA 30519, USA
Mailing Address - Street 2:1232
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519
Mailing Address - Country:US
Mailing Address - Phone:770-680-3799
Mailing Address - Fax:
Practice Address - Street 1:2620 MALL OF GEORGIA BLVD, BUFORD, GA 30519, USA
Practice Address - Street 2:1232
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519
Practice Address - Country:US
Practice Address - Phone:770-680-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker