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General NPI Number Information
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NPI Number | 1912470030
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Entity Type | Individual
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Provider Name | STEPHANIE LORRAIN REEVES FNP
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Gender | Female
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 01/11/2019
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Provider Practice Location Address
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Address Line | 550 PEACHTREE ST NE
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City | ATLANTA
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State | GA
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Zip | 30308-2212
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Country | US
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Telephone | 404-686-4411
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Fax |
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Provider Business Mailing Address
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Address Line | 755 WHITE DOVE DR
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City | MCDONOUGH
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State | GA
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Zip | 30253-9003
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Country | US
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Telephone | 404-952-0010
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN200774
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License Number State | GA
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