Provider Demographics
NPI:1184590382
Name:REYNOLDS, LASHUNDRA
Entity type:Individual
Prefix:
First Name:LASHUNDRA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3893 PRINCETON LAKES PASS SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5598
Mailing Address - Country:US
Mailing Address - Phone:423-304-0478
Mailing Address - Fax:
Practice Address - Street 1:3893 PRINCETON LAKES PASS SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5598
Practice Address - Country:US
Practice Address - Phone:423-304-0478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO108289335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier