Provider Demographics
NPI:1881684041
Name:REID, ALEXANDER BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:BRUCE
Last Name:REID
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 1:717 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4818
Mailing Address - Country:US
Mailing Address - Phone:770-227-4600
Mailing Address - Fax:770-227-9624
Practice Address - Street 1:717 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4818
Practice Address - Country:US
Practice Address - Phone:770-227-4600
Practice Address - Fax:770-227-9624
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056944207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20NCCMFOtherMEDICARE ID-TYPE UNSPECIFIED
GA569040999BMedicaid
GA569040999AMedicaid
GA569040999CMedicaid
GA569040999CMedicaid
GA0437880002Medicare NSC