Provider Demographics
NPI:1881671543
Name:REID, AUBREY JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:AUBREY
Middle Name:JAMES
Last Name:REID
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:AUBREY
Other - Middle Name:JAMES BERNARD
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:7699 HERIOT DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9409
Mailing Address - Country:US
Mailing Address - Phone:910-630-0781
Mailing Address - Fax:
Practice Address - Street 1:2300 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3856
Practice Address - Country:US
Practice Address - Phone:910-488-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10227363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP94568Medicare UPIN
NC2754226AMedicare ID - Type Unspecified