MEDICARE: DR. JEFFREY M. REZNIK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	053872	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538292040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY M. REZNIK M.D.

Provider Business Mailing Address
First Line	:	2520 WINDY HILL RD SE
Second Line	:	SUITE 301
City	:	MARIETTA
State	:	GA
Zip	:	30067-8664
Country	:	US
Telephone Number	:	770-952-1032
Fax Number	:	770-952-8579

Provider Business Practice Location Address
First Line	:	4062 PEACHTREE RD NE STE C
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-3021
Country	:	US
Telephone Number	:	404-365-6500
Fax Number	:	404-365-6501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	04/26/2021

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