MEDICARE: MISS MICHELLE LEA REEVES PA-C

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	363AM0700X	Medical Physician Assistant	004233	GA

General Provider Information

NPI Number	:	1922194018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHELLE LEA REEVES PA-C

Provider Business Mailing Address
First Line	:	4849 PAULSEN ST
Second Line	:	SUITE 300
City	:	SAVANNAH
State	:	GA
Zip	:	31405-4423
Country	:	US
Telephone Number	:	912-354-7546
Fax Number	:

Provider Business Practice Location Address
First Line	:	4849 PAULSEN ST
Second Line	:	SUITE 300
City	:	SAVANNAH
State	:	GA
Zip	:	31405-4423
Country	:	US
Telephone Number	:	912-354-7546
Fax Number	:

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	09/07/2010

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