Provider Demographics
NPI:1922566181
Name:REYNOLDS, CHARLENE (FNP)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HOLLOWAY LN
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6514
Mailing Address - Country:US
Mailing Address - Phone:229-299-3222
Mailing Address - Fax:
Practice Address - Street 1:119 HOLLOWAY LN
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6514
Practice Address - Country:US
Practice Address - Phone:229-236-0143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA093842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily