Provider Demographics
NPI:1558390385
Name:REEVES, DONNY L (MD)
Entity Type:Individual
Prefix:
First Name:DONNY
Middle Name:L
Last Name:REEVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6015
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-6015
Mailing Address - Country:US
Mailing Address - Phone:423-722-1311
Mailing Address - Fax:423-926-0529
Practice Address - Street 1:2328 KNOB CREEK RD
Practice Address - Street 2:SUITE 506
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2584
Practice Address - Country:US
Practice Address - Phone:423-722-1311
Practice Address - Fax:423-926-0529
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38547207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010089018Medicaid
I09587Medicare UPIN
3895953Medicare ID - Type Unspecified