Provider Demographics
NPI:1477549277
Name:REEVES, JOHN R T III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R T
Last Name:REEVES
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2060 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4177
Mailing Address - Country:US
Mailing Address - Phone:706-738-4442
Mailing Address - Fax:706-738-3841
Practice Address - Street 1:2060 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4177
Practice Address - Country:US
Practice Address - Phone:706-738-4442
Practice Address - Fax:706-738-3841
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050253207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00943654AMedicaid
GA4045714OtherAETNA HEALTH
GA5991821OtherCIGNA HEALTHCARE
SCG50253Medicaid
GA702726OtherBLUE CROSS/BLUE SHIELD GA
GA5991821OtherCIGNA HEALTHCARE
GA07BBSKFMedicare ID - Type Unspecified