Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY002497 | GA |
Y | 103T00000X | Psychologist | PSY002497 | GA |
NPI | 1013060227 |
---|---|
Provider Name | Dr. Anne W. Reynolds |
First Address | Athens, GA 30606-4740 |
Second Address | Athens, GA 30606-4740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/07/2007 |