MEDICARE: KAREN LYNNE REEVES RDN, LD

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	133V00000X	Registered Dietitian		GA

General Provider Information

NPI Number	:	1568946689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LYNNE REEVES RDN, LD

Provider Business Mailing Address
First Line	:	PO BOX 1798
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30162-1798
Country	:	US
Telephone Number	:	706-295-6485
Fax Number	:	706-802-5506

Provider Business Practice Location Address
First Line	:	1 JACKSON HILL DR NE
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-5205
Country	:	US
Telephone Number	:	706-295-6485
Fax Number	:	706-802-5506

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

Provider Enumeration Date	:	09/25/2018
Last Update Date	:	09/25/2018

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