Provider Demographics
NPI:1750191896
Name:NOEL, REGINALD
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:NOEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 CAMDYN CIR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-2406
Mailing Address - Country:US
Mailing Address - Phone:404-931-1031
Mailing Address - Fax:
Practice Address - Street 1:222 RIVER PARK NORTH DR # A
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7834
Practice Address - Country:US
Practice Address - Phone:470-400-3425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies