Provider Demographics
NPI:1053320127
Name:REETHS, THOMAS E (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:REETHS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 BOXWOOD TER
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30005-7217
Mailing Address - Country:US
Mailing Address - Phone:770-330-7179
Mailing Address - Fax:
Practice Address - Street 1:5655 ATLANTA HWY STE A
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-5208
Practice Address - Country:US
Practice Address - Phone:770-343-6364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-06
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010064207Q00000X
GA82068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4267635Medicaid
MI4267635Medicaid
MIF32634Medicare UPIN