Provider Demographics
NPI:1649348962
Name:REYNOLDS, MONA ELAINE (D C)
Entity type:Individual
Prefix:MRS
First Name:MONA
Middle Name:ELAINE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 311127
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31131
Mailing Address - Country:US
Mailing Address - Phone:404-344-8055
Mailing Address - Fax:
Practice Address - Street 1:3079 CAMPBELLTON ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311
Practice Address - Country:US
Practice Address - Phone:404-344-8055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor