Provider Demographics
NPI:1952832107
Name:USEDOM, REID
Entity Type:Individual
Prefix:
First Name:REID
Middle Name:
Last Name:USEDOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70621
Mailing Address - Street 2:DEPARTMENT OF FAMILY MEDICINE - QUILLEN COLLEGE OF MED
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614
Mailing Address - Country:US
Mailing Address - Phone:423-439-4683
Mailing Address - Fax:423-439-2440
Practice Address - Street 1:208 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7343
Practice Address - Country:US
Practice Address - Phone:423-989-4050
Practice Address - Fax:423-990-3044
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-01631207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program