Healthcare Provider Details

I. General information

NPI: 1710103619
Provider Name (Legal Business Name): JOHN C REYES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6335 HOSPITAL PKWY SUITE 204
JOHNS CREEK GA
30097-1551
US

IV. Provider business mailing address

6335 HOSPITAL PKWY SUITE 204
JOHNS CREEK GA
30097-1551
US

V. Phone/Fax

Practice location:
  • Phone: 404-446-2496
  • Fax: 404-446-2497
Mailing address:
  • Phone: 404-446-2496
  • Fax: 404-446-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number064060
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD130914
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: