Healthcare Provider Details

I. General information

NPI: 1477549277
Provider Name (Legal Business Name): JOHN R T REEVES III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 CENTRAL AVE
AUGUSTA GA
30904-4177
US

IV. Provider business mailing address

2060 CENTRAL AVE
AUGUSTA GA
30904-4177
US

V. Phone/Fax

Practice location:
  • Phone: 706-738-4442
  • Fax: 706-738-3841
Mailing address:
  • Phone: 706-738-4442
  • Fax: 706-738-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number050253
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: