Provider Demographics
NPI:1720182017
Name:REID, WALTER W III (DMD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:W
Last Name:REID
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 MONTCALM DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8421
Mailing Address - Country:US
Mailing Address - Phone:404-344-1137
Mailing Address - Fax:404-344-7810
Practice Address - Street 1:570 W LANIER AVE
Practice Address - Street 2:BLDG #2
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7649
Practice Address - Country:US
Practice Address - Phone:678-836-2128
Practice Address - Fax:770-460-7307
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice