Healthcare Provider Details

I. General information

NPI: 1205464971
Provider Name (Legal Business Name): CHRISTOPHER VELEZ REYES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 SHAKERAG HL
PEACHTREE CITY GA
30269-3365
US

IV. Provider business mailing address

105 IVER PL APT 305
FAYETTEVILLE GA
30214-4606
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-2150
  • Fax: 770-632-6189
Mailing address:
  • Phone: 908-723-9969
  • Fax:

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 State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number96860
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: