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General NPI Number Information
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NPI Number | 1538292040
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Entity Type | Individual
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Provider Name | JEFFREY M. REZNIK M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 4062 PEACHTREE RD NE STE C
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City | BROOKHAVEN
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State | GA
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Zip | 30319-3021
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Country | US
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Telephone | 404-365-6500
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Fax | 404-365-6501
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Provider Business Mailing Address
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Address Line | 2520 WINDY HILL RD SE SUITE 301
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City | MARIETTA
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State | GA
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Zip | 30067-8664
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Country | US
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Telephone | 770-952-1032
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Fax | 770-952-8579
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 053872
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License Number State | GA
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