Provider Demographics
NPI:1508810888
Name:REEDER, SALLY W (NP)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:W
Last Name:REEDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2469
Mailing Address - Country:US
Mailing Address - Phone:770-464-0280
Mailing Address - Fax:770-464-0233
Practice Address - Street 1:1016 E SPRING ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2469
Practice Address - Country:US
Practice Address - Phone:770-464-0280
Practice Address - Fax:770-464-0233
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN124766363L00000X, 363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10044973OtherAMERIGROUP
GA000915307JMedicaid
GA000915307Medicaid
GA333436OtherWELLCARE OF GEORGIA
GA000915307IMedicaid
GA000915307Medicaid
GA50BBHLSMedicare PIN
GAP00723983Medicare PIN
GA333436OtherWELLCARE OF GEORGIA