Healthcare Provider Details

I. General information

NPI: 1417949777
Provider Name (Legal Business Name): MATTHEW J RESCHLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 RIVERSIDE PKWY STE 100
LAWRENCEVILLE GA
30043-5926
US

IV. Provider business mailing address

268 RUMSON RD NE
ATLANTA GA
30305-3114
US

V. Phone/Fax

Practice location:
  • Phone: 470-273-7233
  • Fax:
Mailing address:
  • Phone: 404-323-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number053393
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number053393
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number053393
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: