Provider Demographics
NPI:1053468694
Name:REAGAN, LYNDA FRANKENA (PT)
Entity type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:FRANKENA
Last Name:REAGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:190 BOSTWICK RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30054-2834
Mailing Address - Country:US
Mailing Address - Phone:770-784-1893
Mailing Address - Fax:770-784-1893
Practice Address - Street 1:190 BOSTWICK RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:GA
Practice Address - Zip Code:30054-2834
Practice Address - Country:US
Practice Address - Phone:770-784-1893
Practice Address - Fax:770-784-1893
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0024372080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6403075OtherUNITED HEALTHCARE