Healthcare Provider Details

I. General information

NPI: 1881221240
Provider Name (Legal Business Name): EVAN DANIEL REUTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 HIGHWAY 54 W BLDG 500
FAYETTEVILLE GA
30214-4574
US

IV. Provider business mailing address

1336 HIGHWAY 54 W BLDG 500
FAYETTEVILLE GA
30214-4574
US

V. Phone/Fax

Practice location:
  • Phone: 770-461-1238
  • Fax: 770-460-6610
Mailing address:
  • Phone: 770-461-1238
  • Fax: 770-460-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number322827
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number102506
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: