Provider Demographics
NPI:1992024798
Name:MACLELLAN, REID AUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:REID
Middle Name:AUSTIN
Last Name:MACLELLAN
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 1:99 WALNUT ST
Mailing Address - Street 2:UNIT 205
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1134
Mailing Address - Country:US
Mailing Address - Phone:205-903-7846
Mailing Address - Fax:
Practice Address - Street 1:99 WALNUT ST
Practice Address - Street 2:UNIT 205
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1134
Practice Address - Country:US
Practice Address - Phone:205-903-7846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program