=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558390385
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONNY L REEVES MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2006
-----------------------------------------------------
Last Update Date | 03/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2328 KNOB CREEK RD SUITE 506
-----------------------------------------------------
City | JOHNSON CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37604-2584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-722-1311
-----------------------------------------------------
Fax | 423-926-0529
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6015
-----------------------------------------------------
City | JOHNSON CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37602-6015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-722-1311
-----------------------------------------------------
Fax | 423-926-0529
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 38547
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------