Provider Demographics
NPI:1750529764
Name:WOOTEN-REED, CANDACE RENEE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:RENEE
Last Name:WOOTEN-REED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 MUIRFIELD PL
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-1635
Mailing Address - Country:US
Mailing Address - Phone:404-446-3870
Mailing Address - Fax:404-446-3875
Practice Address - Street 1:550 PEACHTREE ST NE STE 1700
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2262
Practice Address - Country:US
Practice Address - Phone:404-881-9727
Practice Address - Fax:704-801-2001
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03360363AM0700X
MI5601005386363AM0700X
GA007386363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8102163Medicaid
NCNC7392NMedicare PIN
NC8102163Medicaid
NCNC7392LMedicare PIN
NCNC7392HMedicare PIN
NCNC7392MMedicare PIN
NCNC7392DMedicare PIN
NCNC7392FMedicare PIN
NCNC7392CMedicare PIN
NCNC7392EMedicare PIN
NCNC7392BMedicare PIN
NCNC7392GMedicare PIN
NCNC7392IMedicare PIN
NCNC7392AMedicare PIN
NCNC7392KMedicare PIN
NCNC7392OMedicare PIN