Basic Information
| Provider Information | |||||||||
| NPI: | 1639374283 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REINGOLD | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | SETH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1838 AMERICAN WAY | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300436611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709957622 | ||||||||
| FaxNumber: | 7709957854 | ||||||||
| Practice Location | |||||||||
| Address1: | 5669 PEACHTREE DUNWOODY RD. NE | ||||||||
| Address2: | SUITE 315 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788436400 | ||||||||
| FaxNumber: | 6788436405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2007 | ||||||||
| LastUpdateDate: | 04/16/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 064255 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 003118762A | 05 | GA | MEDICAID | 003118775B | 05 | GA | MEDICAID | 003118775C | 05 | GA | MEDICAID | 003118775A | 05 | GA | MEDICAID | 003118762B | 05 | GA | MEDICAID |