Provider Demographics
NPI:1295758795
Name:REID, MARVIN WALTER (MD)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:WALTER
Last Name:REID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:119 AMBULANCE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-838-8824
Mailing Address - Fax:770-836-9261
Practice Address - Street 1:705 DIXIE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3818
Practice Address - Country:US
Practice Address - Phone:770-838-8929
Practice Address - Fax:770-838-8930
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-05-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA039663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G27153Medicare UPIN