Provider Demographics
NPI:1043842073
Name:REESE, JERRY JR (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:REESE
Suffix:JR
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 ELAM ST
Mailing Address - Street 2:
Mailing Address - City:GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:31031-2502
Mailing Address - Country:US
Mailing Address - Phone:478-628-5888
Mailing Address - Fax:
Practice Address - Street 1:218 ELAM ST
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:GA
Practice Address - Zip Code:31031-2502
Practice Address - Country:US
Practice Address - Phone:478-628-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer