Healthcare Provider Details

I. General information

NPI: 1902863848
Provider Name (Legal Business Name): VICKI H REECE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 LACY ST NW SUITE B
MARIETTA GA
30060-1114
US

IV. Provider business mailing address

140 LACY ST NW SUITE B
MARIETTA GA
30060-1114
US

V. Phone/Fax

Practice location:
  • Phone: 770-426-4721
  • Fax: 678-797-4119
Mailing address:
  • Phone: 770-426-4721
  • Fax: 678-797-4119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN069821
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: