Healthcare Provider Details

I. General information

NPI: 1184619363
Provider Name (Legal Business Name): REGINALD NESBITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 WALTON WAY
AUGUSTA GA
30901-2612
US

IV. Provider business mailing address

5665 NEW NORTHSIDE DR NW
ATLANTA GA
30328-5831
US

V. Phone/Fax

Practice location:
  • Phone: 706-774-2176
  • Fax:
Mailing address:
  • Phone: 770-874-5468
  • Fax: 770-874-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number058300
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: