Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC0000000668 | TN |
NPI | 1568646446 |
---|---|
Provider Name | Dr. Henry Lamar Reid III |
First Address | Dayton, TN 37321-7906 |
Second Address | Dayton, TN 37321-7906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2007 |
Last Update Date | 28/12/2007 |