Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC0000001064 | TN |
NPI | 1649295643 |
---|---|
Provider Name | Lori Fox Reid |
First Address | Dayton, TN 37321-7906 |
Second Address | Dayton, TN 37321-7906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |