DESTINA SHANTE REID (NPI# 1790311223) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790311223 |
| Entity Type | Individual |
| Full Name | DESTINA SHANTE REID |
| Other Name | DESTINA SHANTE CAMPBELL |
| Credential | PA-C |
| Practice Address |
108 Edgewood Ave Lagrange GA 30241-6116 |
| Practice Telephone | 7064150370 |
| Mailing Telephone | 7064150370 |
| Enumeration Date | 2020-03-16 |
| Last Update Date | 2020-03-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 9661 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
108 EDGEWOOD AVE |
| City | LAGRANGE |
| State | GA |
| Zip Code | 30241-6116 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073994182 | Pathways Center for Behavioral and Developmental Growth | Community/Behavioral Health | 102 Corporate Park Drive East, Lagrange, GA 30241 | 2015-06-15 |
| 1235303686 | Atlas Neck & Back Center | Chiropractor | 309 N. Morgan St., Suite A, Lagrange, GA 30241 | 2008-04-16 |
| 1578756565 | Richard Freeman Simmons | Dentist | 2219 B West Point Rd, Dr Richard F Simmons, Lagrange, GA 30241 | 2007-08-22 |
| 1013071851 | Troup County School District | Local Education Agency (LEA) | 100 North Davis Road, Lagrange, GA 30241 | 2006-12-19 |
| 1851748172 | Medventures Physical Therapy, LLC | Physical Therapist | 1075 Lafayette Parkway, Ste 220, Lagrange, GA 30241 | 2016-05-17 |
| 1154784205 | Med Ventures Mri, LLC | Radiology | 1075 Lafayette Parkway, Ste 120, Lagrange, GA 30241 | 2016-04-05 |
| 1437514965 | Holly Renee Abbott | Counselor | 104 Harwell Ave, Lagrange, GA 30241 | 2015-12-29 |
| 1386780104 | Andre D Feria Md | Internal Medicine | 142 Old Mill Road, Lagrange, GA 30241 | 2007-01-29 |
| 1356354500 | Mohd Khairul Anam | Internal Medicine | 142 Old Mill Road, Lagrange, GA 30241 | 2006-08-15 |
| 1417914052 | Troup County Health Department | Public Health or Welfare | 1220 Hogansville Rd, Department of Family and Childrens Services Health Cent, Lagrange, GA 30241 | 2006-04-27 |
| Find all providers in zip 30241 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376993477 | Kelsey Lee Hughes | Physician Assistant | 209 Medford Rd, Lagrange, ME 04453-5202 | 2016-06-20 |
| 1932191913 | David Kent Bunde | Physician Assistant | 207 N Townline Rd Ste 201, Lagrange, IN 46761-1325 | 2005-08-17 |
| 1336799733 | Colby Russey | Physician Assistant | 1514 Vernon Rd, Lagrange, GA 30240-4131 | 2019-09-17 |
| 1932683802 | Darrin Coulter | Physician Assistant | 1514 Vernon Rd, Lagrange, GA 30240-4131 | 2018-09-18 |
| 1801249834 | Eleonor Vanover | Physician Assistant | 2500 N Detroit St, Lagrange, IN 46761-1158 | 2016-07-14 |
| 1679950729 | Jordan Martinec | Physician Assistant | 1514 Vernon Rd, Lagrange, GA 30240 | 2015-04-28 |
| 1447643374 | Joseph Steiner | Physician Assistant | 1514 Vernon Rd, Lagrange, GA 30240-4131 | 2015-03-17 |
| 1922403401 | Duncan Leslie Moffitt | Physician Assistant | 300 Medical Drive, Suite 701, Lagrange, GA 30240 | 2014-10-27 |
| 1518373059 | Madelyn Almonte | Physician Assistant | 1503 Orchard Hill Rd, Lagrange, GA 30240-5709 | 2014-07-04 |
| 1275880692 | Ashtyn N Talos | Physician Assistant | 5201 Willow Springs Rd, Ste 290, Lagrange, IL 60525-6537 | 2012-08-06 |
| Find all providers in LAGRANGE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.