Provider Demographics
NPI:1730886912
Name:REKLAYME
Entity type:Organization
Organization Name:REKLAYME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OCTAVIEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:678-387-8719
Mailing Address - Street 1:930 NEW HOPE RD STE 11-420
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-6407
Mailing Address - Country:US
Mailing Address - Phone:470-981-7462
Mailing Address - Fax:
Practice Address - Street 1:2250 SATELLITE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4917
Practice Address - Country:US
Practice Address - Phone:470-981-7462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service