Healthcare Provider Details

I. General information

NPI: 1528379070
Provider Name (Legal Business Name): STEPHANIE T. REESE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 RIVEREDGE PKWY STE 5005TH
ATLANTA GA
30328-4693
US

IV. Provider business mailing address

PO BOX 818
SPRINGFIELD GA
31329-0818
US

V. Phone/Fax

Practice location:
  • Phone: 657-400-5180
  • Fax:
Mailing address:
  • Phone: 912-826-5239
  • Fax: 912-826-5237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT013508
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: