1356580641 NPI number — MICHAEL D. REESE, M.D., P.C.

Table of content: (NPI 1356580641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356580641 NPI number — MICHAEL D. REESE, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL D. REESE, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356580641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9280 HIGHWAY 5
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
DOUGLASVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30134-1501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-944-8485
Provider Business Mailing Address Fax Number:
770-944-8550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9280 HIGHWAY 5
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
DOUGLASVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30134-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-944-8485
Provider Business Practice Location Address Fax Number:
770-944-8550
Provider Enumeration Date:
02/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
REESE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
770-944-8485

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01BDHLQ . This is a "MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 843752 . This is a "BCBS OF GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 2032867 . This is a "AETNA HMO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 310584454 . This is a "CHAMPUS/TRICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 4261769 . This is a "AETNA PPO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 0100389 . This is a "UNITED HEALTHCARE HMO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000173148C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 843752 . This is a "GA FIRST" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 010064309 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 843752 . This is a "BLUE CHOICE PPO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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