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NPI Code Detail

MEDICARE: MARY LATRELLE REESE

MEDICARE: MARY LATRELLE REESE
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
1247ZC0005XClinical Laboratory Director (Non-physician)

General Provider Information

NPI Number : 1649089566
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LATRELLE REESE
Provider Business Mailing Address
First Line : 290 MONTEGO CIR
Second Line :
City : RIVERDALE
State : GA
Zip : 30274-3617
Country : US
Telephone Number : 404-548-3100
Fax Number :
Provider Business Practice Location Address
First Line : 1393 CLEVELAND AVE STE 107EAST
Second Line :
City : EAST POINT
State : GA
Zip : 30344-3423
Country : US
Telephone Number : 404-548-3100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2025
Last Update Date : 01/06/2025

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Directions to “ MARY LATRELLE REESE ” Practice Location

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