Provider Demographics
NPI:1093803686
Name:REEVES, KENNETH W (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:REEVES
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3614 J DEWEY GRAY CIR
Mailing Address - Street 2:STE A
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6602
Mailing Address - Country:US
Mailing Address - Phone:706-863-5635
Mailing Address - Fax:706-860-3462
Practice Address - Street 1:3614 J DEWEY GRAY CIR
Practice Address - Street 2:STE A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6602
Practice Address - Country:US
Practice Address - Phone:706-863-5635
Practice Address - Fax:706-860-3462
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA012129207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD30585Medicare UPIN