Provider Demographics
NPI:1578547584
Name:REEVE, THOMAS E III (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:REEVE
Suffix:III
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 1:157 CLINIC AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4413
Mailing Address - Country:US
Mailing Address - Phone:770-834-3336
Mailing Address - Fax:770-832-2136
Practice Address - Street 1:157 CLINIC AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4413
Practice Address - Country:US
Practice Address - Phone:770-834-3336
Practice Address - Fax:770-832-2136
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA29759208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00344539AMedicaid
GA271249OtherBLUE CROSS
GA30117A003OtherCHAMPUS
GAAETNAOther5417058
GA271249OtherBLUE CROSS