Provider Demographics
NPI:1982857504
Name:REYNOLDS, CAREY WINN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CAREY
Middle Name:WINN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 JOCASSEE LN
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-6032
Mailing Address - Country:US
Mailing Address - Phone:706-982-1597
Mailing Address - Fax:706-782-5779
Practice Address - Street 1:320 SMITH ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-4261
Practice Address - Country:US
Practice Address - Phone:706-982-1597
Practice Address - Fax:706-782-1788
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT002663225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist