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General NPI Number Information
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NPI Number | 1649089566
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Entity Type | Individual
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Provider Name | MARY LATRELLE REESE
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Gender | Female
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 1393 CLEVELAND AVE STE 107EAST
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City | EAST POINT
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State | GA
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Zip | 30344-3423
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Country | US
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Telephone | 404-548-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 290 MONTEGO CIR
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City | RIVERDALE
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State | GA
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Zip | 30274-3617
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Country | US
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Telephone | 404-548-3100
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Fax |
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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 | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number |
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License Number State |
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