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General NPI Number Information
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NPI Number | 1093803686
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Entity Type | Individual
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Provider Name | KENNETH W REEVES M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3614 J DEWEY GRAY CIR STE A
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City | AUGUSTA
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State | GA
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Zip | 30909-6602
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Country | US
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Telephone | 706-863-5635
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Fax | 706-860-3462
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Provider Business Mailing Address
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Address Line | 3614 J DEWEY GRAY CIR STE A
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City | AUGUSTA
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State | GA
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Zip | 30909-6602
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Country | US
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Telephone | 706-863-5635
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Fax | 706-860-3462
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 012129
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License Number State | GA
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